Vascular risk factors in cocaine users with stroke

Abstract

To determine if the classic stroke risk factors, chronic hypertension, diabetes, cigarette smoking, chronic alcohol abuse, older age, and male sex, are also risk factors in cocaine-related ischemic and hemorrhagic stroke. A computer search of ICD-9 codes identified 100 patients admitted to two inner city hospitals between 1986 and 1995 with acute ischemic or hemorrhagic stroke who also tested positive for cocaine in the urine. The case records of these patients were reviewed retrospectively. The ischemic and hemorrhagic stroke groups were compared with a control group of 109 cocaine users without a history of stroke. Multiple logistic regression was performed to see if the classic stroke risk factors independently increased the risk of cocaine-induced ischemic and/or hemorrhagic stroke. A total of 66 stroke patients in the study group had ischemic stroke, whereas 34 had hemorrhagic stroke. The stroke and control groups were similar in racial and gender composition. The mean ages of patients with ischemic and hemorrhagic stroke (both 41 years) were greater than the control group (34 years) (P<.01). Only chronic hypertension (odds ratio [OR] 5.2, P<.0001) and older age (OR 1.08/year increase of age, P<.0006) were independent risk factors for ischemic stroke. Female sex (OR 3.2, P<.015) and older age (OR 1.1/year increase of age, P<.0002) were independent risk factors for hemorrhagic stroke. Chronic hypertension and older age may magnify the risk of cocaine-related ischemic stroke, whereas female sex and older age may increase the risk of cocaine-related hemorrhagic stroke.