Cocaine use and the likelihood of nonfatal myocardial infarction and stroke - Data from the Third National Health and Nutrition Examination survey

Background-Numerous case series have implicated cocaine use as a cause of b oth myocardial infarction (MI) and stroke on the basis of the temporal rela tionship between drug use and event onset. Increasing cocaine use in the US population, especially in younger individuals, mandates a more extensive i nvestigation of this relationship. Methods and Results-We determined the association of cocaine use with self- reported physician diagnosis of MI or stroke in a nationally representative sample of 10 085 US adults aged 18 to 45 years who participated in the Thi rd National Health and Nutrition Examination Survey. A total of 46 nonfatal MIs and 33 nonfatal strokes were reported. After adjusting for differences in age, sex, race/ethnicity, education, hypertension, diabetes mellitus, c holesterol level, body mass index, and cigarette smoking, persons who repor ted frequent lifetime cocaine use had a significantly higher likelihood of nonfatal MI than nonusers (odds ratio, 6.9; 95% confidence interval, 1.3 to 58) but not stroke. In this age group, the population-attributable risk pe rcent of frequent cocaine for nonfatal MI was estimated as 25%, Conclusion-Regular cocaine use was associated with an increased likelihood of MI in younger patients. Approximately 1 of every 4 nonfatal MIs in perso ns aged 18 to 45 years was attributable to frequent cocaine use in this sur vey. Behavior modification by public awareness and education may reduce the cardiovascular morbidity associated with cocaine use.