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Cocaine abstinence, reduction may lower endothelial dysfunction marker
In a preliminary study, abstinence from or reduction of cocaine use were each associated with a reduction in endothelin-1, indicating a potential for reduced endothelial damage and improved CV outcomes among chronic cocaine users.
The researchers evaluated 57 black cocaine users in Baltimore with coronary stenosis of less than 50% as indicated by CTA. Participants were assessed at baseline and after 6 months via physical examination, blood test and an interview assessing sociodemographic factors, medical history and lifestyle behaviors.
Abstinence from cocaine use was incentivized via a voucher-based program in which participants earned points (valued at $1 each) for negative urine test results during follow-up. Tests occurred twice weekly during the first 4 weeks of cocaine abstinence, with less frequent testing required after longer periods of abstinence, decreasing to a minimum of one test per month after 16 weeks.
The cohort included 16 women and 41 men aged 25 years or older (mean age, 54 years) who had been chronic cocaine users for a median duration of 18 years. The researchers defined chronic use as using cocaine at least four times a month for 6 months or longer. HIV infection was observed in 44 participants.
The median endothelin-1 level was 1.66 pg/mL at baseline and decreased to 1.1 pg/mL during follow-up (P < .0001). The change to endothelin-1 was not significantly different between those who abstained during the 6-month period and those who did not. However, researchers observed significant associations between decreased endothelin-1 and both complete cocaine abstinence (P = .041) and a reduction in use (P = .021) after adjustment for confounders.
Overall, coronary plaque progression occurred in 15.1 cases per 100 patient-years. Among patients who were completely abstinent from cocaine use during follow-up, the incidence rate of progression was 7.4 per 100 person-years vs. 23.1 per 100 person-years among those who continued use (P = .3).
“The findings of this study revealed a possible association of cocaine abstinence/reduction with lowered [endothelin-1] levels, which suggests that such changes in cocaine use might be beneficial for preventing endothelial damage,” the researchers concluded. “Further studies should be conducted to investigate whether [endothelin-1] could be used as a marker for cocaine abstinence and reduction in cocaine use.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.