Around 5 million people use cocaine each year in the United States, but many don’t know about the potentially fatal cardiac side effects. [1] New research has helped to quantify heart damage from cocaine and alcohol use by using specific biomarkers in the bloodstream. [2] This article will help to break down this new research and provide tips on how to reduce cardiovascular risk.
How cocaine affects the heart
Cocaine use causes both acute and chronic changes to the heart, primarily by inducing anatomical and physiological changes to the heart muscle cells. [3] Even short-term recreational cocaine use can lead to dysfunction of the major metabolic and contractile processes in the cardiac cells. [4] This can lead to several severe immediate effects, including potentially fatal arrhythmias. It can also cause myocardial infarction (heart attack) even in young people, which can be related to cocaine-induced spasm of the coronary arteries. [5]
If cocaine use is regular and prolonged, this process is exacerbated further, leading to cardiac cell death, fibrosis, and hypertrophy. [4] This can result in permanent damage and increased risk of heart disease, even after stopping use, as the heart muscles can become weaker and enlarged, a process called cardiomyopathy. Additionally, cocaine causes increased heart rate and blood pressure, which, over time, can lead to hardening of the blood vessels around the heart, reducing oxygen supply to the heart muscles.
It’s clear that cocaine use is very dangerous, and even using it once has the potential to cause long-term cardiac effects.
Cutting-edge science: What's new?
A recent study has helped to quantify heart damage from both cocaine and alcohol use by measuring cardiac biomarkers (troponin T & I) in these sample groups. [2] The troponin levels are highly sensitive and are generally used as a marker for heart attacks. Troponins T & I have similar functions relating to cardiac muscle contraction, and both are released into the bloodstream following heart muscle damage.
The study found that individuals with cocaine use disorder had higher levels of troponin T compared to the control, while alcohol use caused an increase in troponin I levels. [2] This highlights that both cocaine and alcohol use have a direct impact on heart muscle damage, which is further exacerbated if they are both consumed together.
Raised troponin T levels in individuals with a history of cocaine use but without any other signs of established cardiovascular disease indicate that it could cause some subclinical, or ‘silent’, damage to the heart. [2] The study found this was the case even in individuals who are now abstinent following previous cocaine use. [2] The effect of illicit stimulants like cocaine on the heart has been linked to almost 1 million years of lost life between 2014 and 2023. [6]
The lethal mix: Cocaine and alcohol
With cocaine causing an increase in troponin T, and alcohol increasing troponin I, they are affecting the heart in distinct ways. Combined, the risk of sudden cardiac death is increased by up to 25 times compared to cocaine use alone. [7] This is due to a substance called cocaethylene, which is formed in the liver when cocaine and alcohol are present together in the bloodstream. [8]
Cocaethylene is a psychoactive substance with similar properties to cocaine; however, it stays in the body much longer, with a half-life up to five times that of cocaine. [9] This prolonged presence in the body has been linked with significantly increased cardiac risks, along with seizures, liver damage, and reduced function of the immune system. [9] Those with underlying health issues and who take cocaine with alcohol regularly are most vulnerable to these adverse effects.
Warning signs, screening, and "silent injury"
If any of the following symptoms are experienced after taking cocaine, urgent medical attention is required, as it could indicate a serious heart problem:
- Chest pain
- Shortness of breath
- Feeling faint or passing out
- Seizures
- Loss of consciousness
Several symptoms can be experienced after historical cocaine use, which could indicate problems with the heart. These would warrant seeing a clinician to arrange the necessary investigations, and include:
- Feeling pain in the chest on exertion (angina)
- Feeling more short of breath on exertion
- Feeling more short of breath when lying flat
- Feeling faint during exercise
- Swelling in the ankles and legs
Screening for silent injuries
Sometimes, individuals may experience no symptoms despite having damage to the heart from cocaine, demonstrating the importance of cardiac screening. Whilst there is no standardized screening program in this group, healthcare providers may consider the following tests depending on the individual risk factors:
- Basic cardiac risk assessment: Blood pressure, pulse, lipid profile, diabetes screen.
- 12-lead echocardiogram (ECG) to check for any arrhythmias in the electrical signaling in the heart.
- Echocardiogram to check for any structural abnormalities.
- In-depth scans, such as a cardiac MRI or angiogram, could be considered depending on symptoms.
If you are worried about heart damage from cocaine use, please discuss this with your healthcare provider.
Recovery & risk reduction
While heart function can improve following cocaine abstinence, scarring of the heart muscles from prolonged use and damage to the coronary arteries is generally irreversible. It’s therefore vital to seek help with recovery from a medical professional if you, or someone you know, is struggling with cocaine use. It’s never too early to reach out for help, and this can help reduce the risk of long-term cardiac consequences of cocaine use. There are also lots of support groups available, such as Narcotics Anonymous, which can provide support when quitting cocaine.
To help reduce the chance of cardiovascular problems in the future, it’s important to optimize the other risk factors for cardiovascular disease by taking the following steps:
- Stop smoking
- Reduce alcohol intake
- Ensure cholesterol levels are in the normal range
- If diabetic, ensure blood sugars are well controlled
- Eat a healthy, balanced diet
- Do regular, moderate-intensity exercise
Following these steps will help keep your cardiovascular system as healthy as possible, even after previous cocaine use.
Final thoughts
Cocaine use can be extremely damaging to the heart, and this is further amplified by drinking alcohol alongside. New research has shown a rise in troponin levels in ex-cocaine users, showing evidence of heart muscle damage even in the absence of symptoms. If you’re struggling to stop using cocaine, please reach out to a medical or mental health professional to start your recovery.
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