Crack cocaine linked to rare heart disease

ANAHEIM, Calif., Nov. 13 (UPI) -- Crack cocaine addicts could face higher risk for aortic dissection, a rare but deadly heart disorder in which the interior lining of the aorta tears to expose the underlying layer, researchers reported at the American Heart Association's annual conference.

"Cocaine causes a rise in stress hormones, or adrenaline, that leads to a rise in blood pressure," said Ann Bolger, an associate professor of medicine at the University of California at San Francisco. "That can cause the inner lining of the aorta to peel away."

That inner lining is called the intima. By peeling off, it can cause blockages that stop blood from getting to organs.

Bolger said the disease is a rare one that usually occurs later in life and typically in people who have hypertension or vascular disease, and especially a disorder called Marfan syndrome that affects the body's connective tissue. Until this study, cocaine had not been recognized as a contributing factor to aortic dissection.

But while working at a hospital that principally served low income African-Americans, Bolger noticed young people suffering from the disease.

"We wanted to find out why," she said.

Working with another researcher, Dr. Priscilla Hsue, a cardiology fellow also at the University of California San Francisco, Bolger analyzed hospital charts of individuals diagnosed with aortic dissection at San Francisco General Hospital from 1981 to 2001.

Out of 38 cases, 14, or 37 percent, had used cocaine prior to entering the hospital. Of those, 13 had smoked crack cocaine. The other had snorted powdered cocaine. Powdered cocaine, which can be snorted or injected, is used to make crack, a smokable form of the drug.

Twenty-nine percent of the cocaine users died while only 7 percent of non-users died from the condition.

The patients' median age when hospitalized was 42, which is 18 years younger than non-cocaine using patients.

Bolger said the patients typically felt chest pains 12 hours after smoking crack.

She said doctors might not typically suspect that a young person with chest pains could be suffering from aortic dissection.

"But because it is so dangerous, if you think someone has it, everything changes," she said.

"Also, typically doctors who don't suspect it might not test for it because tests are expensive and not particularly easy to get in the emergency room."

The need to diagnose quickly is evidenced by the fact that within the first 24 hours of a dissection of the aorta, 25 percent of patients die. By 48 hours, half of the patients die.

"This is an important study and the critical finding is that these cocaine-using patients had aortic dissection 18 years younger than those who didn't," said Dr. Rose Marie Robertson, professor of medicine at Vanderbilt University Medical Center in Nashville, Tenn., and a past president of the American Heart Association. "People can show symptoms but still be walking around, so unless a physician thinks to test specifically for the disease, it can easily be missed. And that is usually catastrophic."

Bolger said patients are typically hesitant to admit drug use, which complicates diagnoses.

She also said the research team did not have data on the amount of drugs the patients used nor the frequency with which they used them.