Abstract W MP57: Illicit Cocaine Use and Risk of Ischemic Stroke: The Stroke Prevention in Young Adults Study

Abstract

Background: Cocaine use has been associated with increased risk of ischemic stroke (IS). The prevalence of illicit cocaine use in the population differs by gender and ethnicity. The goal of this study was to determine the effect of cocaine on young-onset IS in Caucasian and African American men and women. Methods: A total of 1,101 cases and 1,154 controls, aged 15 to 49 years old, were recruited from the greater Baltimore-Washington area between 1992 and 2008. Cases and controls were interviewed to assess the presence of stroke risk factors and history of illicit drug use. Logistic regression was used to determine the association between cocaine use and IS. Results: In this study, 28% of cases and 26% of controls reported a history of illicit cocaine use. Men were twice as likely as women to report a history of cocaine use (36% vs. 18%, P<0.0001), and African Americans slightly more likely than Caucasians (30% vs. 26%, P=0.01). Having a history of illicit cocaine use was not associated with IS in the overall sample or any of the gender and ethnic subgroups. However, reporting acute use of cocaine in the 24 hours prior to stroke was strongly associated with increased risk of IS in the overall sample (2.4% of cases vs. 0.4% of controls; age-adjusted OR=7.1, 95% CI: 2.4-20.3), and the strength of association was similar in Caucasians (age-adjusted OR=6.1, p=0.10) and African Americans (age-adjusted OR=6.7, p=0.002). Interestingly, the effect of acute cocaine use appeared to be stronger in females (OR=12.8, p=0.01) than males (OR=2.5, p=0.17) after adjusting for the effect of age, ethnicity and current smoking status although the gender difference in ORs was not statistically significant. Conclusions: Our data suggests that acute cocaine use significantly increases IS risk in young adults, and that the effect appears to be stronger in women despite the lower frequency of cocaine use in this subgroup.