Download Lack of association of recreational cocaine and alcohol use

JACC Vol. 25, No. 4
March 15, 1995:895 900
895
C O C A I N E USE
Lack of Association of Recreational Cocaine and Alcohol Use With
Left Ventricular Mass in Young Adults
The Coronary Artery Risk Development in Young Adults (CARDIA) Study
GEORGEANNE
S. H O E G E R M A N ,
J A M E S M. R A C Z Y N S K I ,
M D , C O R A E. L E W I S , M D , M S P H , J O H N F L A C K , M D , M P H , *
PI-ID,* J E N N I F E R
CAVENY,
MS, J U L I U S M. G A R D I N ,
M D , FACC'["
Birmingham, Alabama; Minneapolis. Minnesota; and Orange, California
Objectives. This study examined the associations of left ventricular mass with self-reported cocaine and alcohol use prevalent in
the young adult population.
Background. Increased left ventricular mass has been associated with long-term use of cocaine and alcohol; however, few of the
published studies have been population based.
Methods. Data from 3,446 black and white participants (mean
age 29.9 years) in the Coronary Artery Risk Development in
Young Adults (CARDIA) study were used to examine the associations between echocardiographically measured left ventricular
mass obtained from 1990 to 1991 and self-reported cocaine and
alcohol use. Categories of cocaine use were those who denied ever
using cocaine (n = 2,122), experimental users who admitted to
cocaine use only 1 to 10 times in their lifetime (n = 755) and
recurrent users who admitted to cocaine use >10 times in their
lifetime (n = 568). For alcohol consumption, categories were
abstainers who consistently denied any alcohol consumption in
the year before each of the three CARDIA examinations (n = 275),
occasional users who admitted consuming alcohol less than once
a week or not at all during the year before the third examination
(n = 1,322), moderate users who consumed 1 to 209 ml of
alcohol/week during the year before the third examination (n =
1,524) and heavy users who consumed >210 ml of alcohol/week
during the year before the third examination (n = 323). Estimated
power to detect a 10% difference in left ventricular mass between
groups was >80%.
Results. For white women, left ventricular mass was significantly higher among those who reported 1 to 10 lifetime uses of
cocaine than in never-users (128.5 g [SE 2.0] vs. 122.7 g [SE 1.4],
p = 0.002). There were no other significant di~erences in left
ventricular mass among categories of cocaine or alcohol use in
unadjusted analyses or among analyses controlling for age, body
mass index, alcohol or cocaine use, physical activity, cigarette
smoking status and systolic blood pressure.
Conclusions. At the levels of consumption reported, neither
cocaine nor alcohol use was associated with left ventricular mass
in this cohort of healthy young adults.
Increased left ventricular mass as measured by echocardiography precedes the clinical presentation of some forms of cardiac
disease (i.e., congestive heart failure, hypertensive cardiomyopathy) (1-5) and is itself a risk factor for cardiovascular
mortality (5,6). Several recent studies (7-11) have reported an
association of left ventricular mass with long-term use of either
cocaine or alcohol. Increased left ventricular mass has been
reported among long-term male cocaine abusers admitted to a
Veterans Affairs hospital for treatment of cocaine addiction
compared with age-matched male nonusers (7). Studies of
alcoholic subjects (8-11) and Framingham study participants
(12) have also shown associations of alcohol intake with left
ventricular mass.
However, interpretation of much of the available data is
limited because of small sample sizes, lack of appropriate control
subjects and failure to adjust for tobacco consumption and other
confounders. Furthermore, few studies have examined these
associations in general population samples, where use patterns
differ markedly from samples of patients seeking treatment for
abuse or for medical consequences of substance use. Finally,
there have been few studies examining associations of left ventricular mass with use of cocaine or alcohol in women and blacks.
Thus, we examined the associations of left ventricular mass with
self-reported cocaine and alcohol use in a large, well described,
longitudinal population-based sample to determine the relevance
of prevalent cocaine and alcohol use to left ventricular mass in the
young adult population.
From the Division of Preventive Medicine, Departments of Medicine and
Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama;
*Division of General Internal Medicine, University of Minnesota, Minneapolis,
Minnesota; and tDivision of Cardiology, Department of Medicine, University of
California-Irvine Medical Center, Orange, California. This study was supported
by Contracts N01-HC-48047, N01-HC-48048, N01-HC-48049, NOI-HC-48050,
N01-HC-95095 and N01-HC-95100 from the National Heart, Lung, and Blood
Institute, National Institutes of Health, Bethesda, Maryland.
Manuscript received July 14, 1994; revised manuscript received October 27,
1994, accepted November 1, 1994.
Address for corremondence: Dr. Cora E. Lewis, 1717 1lth Avenue South,
Room 734, Birmingham, Alabama 35205.
© 1995 by the American College of Cardiology
(J Am Coll Cardiol 1995;25:895-900)
0735-1097/95/$9.50
0735-1097(94)00469-7
896
H O E G E R M A N ET AL.
C O C A I N E AND LEFT V E N T R I C U L A R MASS
Methods
Study population. The Coronary Artery Risk Development in Young Adults (CARDIA) study is a prospective
epidemiologic study designed to determine the antecedents of
cardiovascular disease risk factors in young adults and to
identify health habits and behaviors that predict the levels of,
and changes in, these risk factors. During 1985 and 1986, 5,115
young adults 18 to 30 years old were recruited from four cities:
Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. The study population was
approximately balanced at baseline according to age (18 to 24
and 25 to 30 years), gender, race (black and white) and
educational level (high school graduate or less and beyond
high school). Details of the study design and participant
characteristics at baseline have been described elsewhere (13).
The study was approved by the institutional review committee
of each center; examination procedures followed established
human use guidelines. Participants gave written informed
consent at each examination.
Ninety-one percent of the surviving participants returned
during 1987 to 1988 for a second examination, and 86%
returned for a third examination during 1990 to 1991, when
echocardiography was performed. Retention rates for the third
examination were similar for various categories of alcohol or
cocaine use: 89% of those who admitted to consuming
>210 ml of alcohol/week at the second examination returned
for the third examination, compared with 88% of alcohol
abstainers; 91% of those who admitted to >10 lifetime uses of
cocaine at the second examination returned for the third
examination, compared with 89% of those who denied ever
using cocaine.
The study sample included 3,446 of the 4,352 participants
attending both the second and third examinations. We excluded from analyses 238 participants who had missing drug
use data at the second examination, 34 who had missing drug
use data at the third examination, 180 who had missing left
ventricular mass data and 277 who had inconsistent drug use
data (participants reporting any drug use at the second examination who denied ever having used drugs at the third
examination).
Data collection. Drug and alcohol use. Self-administered
questionnaires given at both the second and third examinations
were used to determine whether a participant had ever used a
variety of illicit drugs (marijuana, cocaine, opiates or amphetamines). Follow-up questions quantified use of each drug over
the participant's lifetime and use within the previous 30 days.
As described previously (14), alcohol consumption was determined at each examination by an interviewer-administered
questionnaire that quantified the number of drinks consumed
per week of wine (5 oz [148 ml]), beer (12 oz [355 mlD and
liquor (1.5 oz [44 ml]). The total milliliters of absolute alcohol
consumed per week was calculated as follows: [(Wine ×
17.02) + (Beer × 16.7) + (Hard liquor x 19.09)].
Echocardiography. The echocardiographic protocol used in
the CARDIA study was very similar to that previously de-
JACC Vol. 25, No. 4
March 15, 1995:895-900
scribed for the Cardiovascular Health Study (15). M-mode and
two-dimensional echocardiograms were obtained with patients
lying in the left lateral decubitus position using a 2.5-MHz
Acuson phased-array sector scanner. Stop-frame M-mode and
real-time two-dimensional images were recorded at 30
frames/s on 0.5-in. super-VHS tape and sent to the central
Echocardiography Reading Center, University of CaliforniaIrvine. For each participant, the two-dimensional parasternal
long-axis view, parasternal short-axis view at the level of the
papillary muscle tips and the apical four and two-chamberviews were obtained. M-mode images of the left ventricle were
recorded using two-dimensional parasternal images to direct
the M-mode cursor perpendicular to the ventricular septum
and left ventricular posterior wall at approximately the level of
the mitral leaflet tips. All recordings were performed with
respiration suspended at midexpiration.
Measurements were made from digitized images using a
Dextra D-200 off-line image analysis system. Images were
played back on a super-VHS videotape recorder and digitized
at 30 frames/s in real time. All measurements were traced on a
video screen using a digitizer, with primary measurement data
going directly into a dBase IV data base (Ashton-Tate).
Quality control measures for echocardiography included standardized training of echocardiographic technicians and readers, technician observation by a trained echocardiographer,
blind duplicate readings to establish intrareader (4% sample)
and interreader (8% sample) measurement variability, periodic review sessions, phantom studies on the ultrasound equipment and quality control audits.
M-mode left ventricular mass was calculated from the formula of Devereux et al. (16) with the correction factor for
measurements performed using the following American Society of Echocardiography convention (17): Left ventricular
mass (g) = 0.08 {1.04[(VSTd + LVIDd + PWTd) 3 (LVIDd)3]} + 0.6, where VSTd = ventricular septal thickness
at end-diastole (cm); LVIDd = left ventricular internal dimension at end-diastole (cm); and PWTd = left ventricular posterior wall thickness at end-diastole (cm). Left ventricular internal dimension at end-systole (cm) was also determined from
M-mode images. Average values from 3 beats were used in
analyses; measurements were made on a stop-frame superVHS image from cycles in which the right and left side of the
ventricular septum, and the endocardial and the epicardial
interfaces of the left ventricular posterior wall, were clearly
defined.
Other factors. Potential confounding factors included age,
race, gender, height, body mass index, physical activity, cigarette smoking and blood pressure. Body weight was measured
in light clothing to the nearest 0.5 lb (0.227 kg) with a
calibrated balance-beam scale; height (without shoes) was
measured to the nearest 0.5 cm using a vertical ruler. Body
mass index was computed as follows: [Weight (lb)/2.2]/[Height
(cm)/100] 2. Physical activity was assessed using the reported
frequency of participation in each of 13 physical activities
during the previous year, weighted by the intensity level of
each activity, and then summed to give a total physical activity
JACC Vol. 25, No. 4
March 15, 1995:S95-900
score (18). Self-reported measures of cigarette smoking
(present, past and never) (19), age at the third examination,
race and gender were also used in analyses. Three sitting blood
pressure measurements were obtained, after a 5-min rest and
at l-rain intervals from the right arm of all participants; the
average of the second and third measurements was used in
analyses. Trained and certified technicians used a Hawksley
random-zero sphygmomanometer (W. A. Baums Co.) and
common protocols for blood pressure measurements.
Statistical analysis. Three categories were created to evaluate cocaine use at the third examination on the basis of the
participants' report of any lifetime use of cocaine. These
categories divided the cohort (n = 3,446) into those who
denied ever using cocaine (n = 2,122), experimental users who
admitted to cocaine use only 1 to 10 times in their lifetime (n =
755) and recurrent users who admitted to cocaine use >10
times in their lifetime (n = 568). The latter category included
participants reporting 11 to 99 lifetime uses and ->100 uses,
which were combined because of small numbers in the highest
category. Because only 94 participants admitted using cocaine
within 30 days of their third CARDIA examination, stratification for this use pattern was not done because of small
numbers in the race-gender groups. Cocaine use could not be
further separated from use of other illicit drugs because only
two participants admitted exclusive use of cocaine. The small
number of participants (n = 9) who admitted to use of other
illicit drugs (i.e., opiates or amphetamines) in the absence of
marijuana or cocaine use precluded separate analyses of these
groups.
We created categories to evaluate alcohol use in participants for whom data were available on alcohol consumption
(n = 3,129); categories were based on the findings of an
association between alcohol intake and left ventricular mass in
Framingham subjects (12). We defined abstainers as participants who consistently denied any alcohol consumption (i.e.,
those who denied any use in the year before each of their three
CARDIA examinations [n = 275]). Definitions of the other
categories were based on current use (i.e., that reported during
the year before the third examination). Occasional users
admitted consuming alcohol less than once a week or not at all
during the year before the third examination (n = 1,322);
moderate users admitted consuming 1 to 209 ml of alcohol/
week during this period (n = 1,524); and heavy users admitted
consuming ->210 ml of alcohol/week (n = 323). To examine
the effects of larger intakes of alcohol and the stability of
findings at different levels, we also examined associations for
those consuming 1 to 350 ml of alcohol/week (n = 1,705) and
those consuming >350 ml of alcohol/week (n = 142); however,
because the results were similar, these data are not presented.
We excluded from analyses 177 participants who were
known to be hypertensive (self-reported history of antihypertensive drug use or systolic blood pressure >140 mm Hg or
diastolic blood pressure >90 mm Hg at examination). However, data that included participants with hypertensive blood
pressure levels who were not taking antihypertensive medication yielded similar results to those reported here.
H O E G E R M A N ET AL.
COCAINE AND LEFT V E N T R I C U L A R MASS
897
Associations of left ventricular mass and baseline characteristics of potential confounders were examined between
race-gender groups using analysis of variance and chi-square
tests where appropriate. Pairwise comparisons were tested
using the Scheff6 procedure (20). Associations of unadjusted
left ventricular mass with cocaine and alcohol use were examined with trend tests within the race-gender groups (21).
Analysis of covariance was also used to examine associations of
left ventricular mass with cocaine and alcohol use for the
race-gender groups, controlling for significantly confounding
factors, including systolic blood pressure, age, physical activity,
smoking status and alcohol or cocaine consumption. Analyses
were repeated, controlling for number of cigarettes smoked
per day (0 for nonsmokers and for ex-smokers) instead of
smoking status; these findings are not presented because of
similar results. Separate models were used to control for body
mass index and height. The experimental error rate of alpha
0.05 was adjusted with a Bonferonni correction, depending on
the number of comparisons made (20). Analyses were performed with SAS version 6.04 software.
Results
Because of the initial eligibility criteria, the sample was
young (mean age 29.9 years), had higher than a high school
education on average and had approximately equal representation from black and white, as well as male and female, groups
(Table 1). Left ventricular mass was significantly greater in
men than in women and in blacks than in whites. There were
also significant race- or gender-related differences, or both, in
cocaine and alcohol use and in demographic and other characteristics of the participants. Although >50% of the participants denied ever having smoked tobacco or used cocaine,
<10% of the cohort consistently reported that they abstained
from alcohol use at each of the three examinations.
Left ventricular mass was not consistently associated with
either increased cocaine (Table 2) or alcohol use (Table 3)
when compared with that of nonusers of these substances. In
unadjusted analyses, cocaine was associated with left ventricular mass only among white women; however, a clear doseresponse association was not present in pairwise comparisons
(Table 2). No significant associations with alcohol were present
(Table 3). When the data were adjusted for height as well as
other potential confounders (systolic blood pressure, age,
physical activity, smoking status, alcohol or cocaine consumption), there were again no associations of either cocaine or
alcohol use with left ventricular mass within race-gender
groups (data not shown). In models adjusted for the other
potential confounders and body mass index, the only significant difference found was in white women who reported 1 to 10
lifetime uses of cocaine compared with those who reported
never having used cocaine (129.5 g [SE 1.9] vs. 121.9 g [SE 1.4],
respectively, p = 0.002). Further analyses by type of alcoholic
beverage (beer, wine or liquor) within race-gender groups
revealed no association between left ventricular mass and
alcohol consumption.
898
HOEGERMAN ET AL.
COCAINE AND LEFT VENTRICULAR MASS
JACC Vol. 25, No. 4
March 15, 1995:895-900
Table 1. Characteristics of 3,446 Participants: C A R D I A Study, 1990 to 1991
Men
Age (yr)
Education (yr)
Systolic BP (ram Hg)
Diastolic BP (ram Hg)
Body mass index (kg/m:)
Physical activity, score
LVM (g)
Never smoked tobacco (%)
Never used cocaine (%)
Alcohol abstainers (%)
Women
Black
White
Black
White
29.3 (3.7)*
13.5 (2.1)*
112 (9.4)*,1,
72 (8.5)*,1,
26.4 (5.0)*,1,
488.7 (347.7)t
174.3 (42.6)*t
56t
63't
10"
30.5 (3.4)*
15.3 (2.6)*
109 (9.5)*t
70 (8.3)*+
25.3 (3.8)*+
465.9 (289.9),1,
168.7 (39.5)*,1,
61
50,1,*
5*
29.3 (3.9)*
13.7 (1.9)*
105.4 (9.3)*t
68 (8.7)*t
27.8 (7.2)*t
261.8 (227.5)*i
132.2 (34.9)*t
64",1,
77',1,
13'
30.5 (3.5)*
15.3 (2.4)*
101 (8.6)*t
65 (8.1)*,1,
24.2 (4.8)*,1,
345.0 (247.7)*,1,
125.1 (33.1)*,1,
58*
56*+
6*
*p < 0.0125, race comparison within gender (black men vs. white men, black women vs. white women), tp < 0.0125,
gender comparison within race (black men vs. black women, white men vs. white women), Bonferroni correction 0.05/4 0.0125. Data presented are mean value (SD), unless otherwise indicated. BP - blood pressure; LVM = left ventricular
mass.
Echocardiographic measures of left ventricular internal dimension at end-diastole and end-systole, ventricular septal
thickness at end-diastole and left ventricular posterior wall
thickness at end-diastole were also not significantly associated
with cocaine or alcohol use (data not shown).
Discussion
Our data do not support associations of cocaine or alcohol
use with left ventricular mass at the levels of consumption
reported in this healthy population of black and white young
men and women. The isolated, statistically significant association of left ventricular mass with cocaine use in white women
did not show a monotonic dose-response relation (22) and was
small and inconsistent with the findings in the other racegender groups. Thus, this finding is unlikely to be of clinical
significance,
Previous studies of cocaine and left ventricular mass. Our
results differed from those of others, who have reported
associations of cocaine with left ventricular mass. Brickner et
al. (7) reported that alcohol consumption >210 ml/week and
cocaine abuse were independently associated with left ventricular mass index and posterior wall thickness in men undergoing inpatient treatment for cocaine abuse compared with
hospital house staff and employees matched for race and age
who denied illicit drug use. However, interpretation of these
data is limited because of failure to adjust for tobacco consumption, small sample size, use of a control sample that
differed from the study sample on many characteristics besides
cocaine use and lack of female patients. In addition, the level
and duration of use of cocaine or other substances may have
been substantially different from that typical of CARDIA
Table 3. Unadjusted Left Ventricular Mass (g) by Alcohol
Consumption: C A R D I A Study, 1990 to 1991
Table 2. Unadjusted Left Ventricular Mass (g) by Lifetime Cocaine
Use: C A R D I A Study, 1990 to 1991
Men
Never used cocaine
No.
Mean (SE)
1-10 uses of
cocaine
No.
Mean (SE)
>10 uses of cocaine
No.
Mean (SE)
Overall p value?
p value trend
Men
Women
Black
(n = 662)
White
(n = 862)
(n
Black
923)
White
(n = 998)
417
173.6 (2.1)
433
167.7(1.9)
712
131.6(1.3)
560
122.7(1.4)
119
174.4 (3.9)
235
168.8(2.6)
132
132.8(3.0)
269
128.5(2.0)*
126
176.5 (3.8)
0.80
0.51
194
170.8(2.8)
0.67
0.22
79
136.8(3.9)
0.45
0.38
169
127.3(2.5)
0.04
0.04
*p < 0.025, comparisons within race-gender groups, using never-used
cocaine as reference group; Bonferroni correction 0.05/2 = 0.025. ?Analysis of
variance.
Alcohol abstainers*
No.
Mean (SE)
Alcohol use more than
once a wk
No.
Mean (SE)
1-209 ml alcohol/wk
No.
Mean (SE)
->210 ml alcohol/wk
No.
Mean (SE)
Overall p value+
p value trend
Women
Black
(n = 661)
White
(n - 862)
(n
Black
924)
White
(n = 997)
63
173.4 (5.4)
40
172.6(6.2)
117
131.1 (3.2)
55
122.9(4.5)
196
174.4 (3.0)
207
167.8(2.7)
480
131.4(1.6)
439
126.6(1.6)
276
174.8 (2.6)
492
167.3(1.8)
290
132.8(2.0)
466
123.4(1.5)
126
173.1 (3.8)
0.98
0.94
123
174.5(3.6)
0.28
0.48
37
141.0(5.7)
0.42
0.21
37
129.2(5.4)
0.40
0.64
*p < 0.017, comparisons within race-gender groups, using alcohol abstainers
as reference group; Bonferroni correction 0.05/3 = 0.017. ?Analysis of variance.
JACC Vol. 25, No. 4
March 15, 1995:895 900
participants. In a similar study of 52 male veterans seeking
treatment for crack cocaine addiction, Chakko et al. (23)
reported that 54% were found to have left ventricular hypertrophy by echocardiography, whereas none of the normal
volunteers and psychiatric control patients studied had this
finding. Measures of left ventricular mass were also significantly higher in the abusers than in the control groups.
Limitations of that study were that race was not balanced
across groups (there were many more blacks in the crack users
than in the other groups) and although Chakko et al. stated
that tobacco and alcohol use was similar between crack users
and psychiatric controls, these factors were not controlled for
in the analyses. Finally, the groups were somewhat older on
average (36 years for crack users to 33 years for normal control
subjects) than those in the CARDIA cohort. Numerous other
investigators (24-32) have reported cocaine-associated cardiovascular effects in addition to increased left ventricular mass.
Interpretation of the associations in these retrospective
studies is complicated by many factors, including 1) current
and previous polysubstance use (i.e., alcohol, tobacco and
other drugs) (24-26,29,30,33,34); 2) pattern of cocaine use
(long term, intermittent or short term) (25,26,30,35-37);
3) method of cocaine administration (intranasal, inhalation or
injection) (25,26,31,35-37); 4) life-style associated with illicit
drug use (crime, violence, trauma and stress) (30,34-36); and
5) sample bias (35-38).
Previous studies of alcohol and left ventricular mass.
Other recent studies have addressed the relation between
alcohol consumption and left ventricular mass (8-12). In 4,491
Framingham Study participants (mean age >50 years) who
were free of apparent cardiovascular disease at baseline, left
ventricular mass was independently associated with total alcohol intake in men but not in women (12). The gender
difference was solely attributed to the inverse association of
liquor (as opposed to beer and wine) with left ventricular mass
in women. That study did not address the effect of alcohol
consumption on left ventricular mass in younger adults, which
is the age group with the highest prevalence of heavy drinking
(39,40). Several other studies of alcoholic subjects (8-11) have
also reported an association of alcohol with increased left
ventricular mass; however, it is very difficult to interpret these
findings because of the small sample sizes involved and lack of
control for confounders.
Study limitations. Although we report no association between cocaine or alcohol use and left ventricular mass, extrapolation of our data to other populations should be done
cautiously because of several limitations of this study, First,
although the CARDIA study is a large population-based
sample, the sample sizes of the highest use categories were
relatively small. The relatively low prevalence of heavy cocaine
or alcohol use in our sample may have limited our power to
detect associations of left ventricular mass with use of these
substances. However, we estimate that our power to detect a
10% difference in left ventricular mass between use groups was
>80% in all groups and was frequently >90%. Furthermore,
the level of use in our study may be more reflective of that in
H O E G E R M A N ET AL.
COCAINE AND LEFT V E N T R I C U L A R MASS
899
the general population and thus may better indicate the risk of
increased left ventricular mass attributable to cocaine and
alcohol in the general population. Second, the criteria that we
selected may be too inclusive for both alcohol and cocaine. Our
operational definition of recurrent cocaine use included participants who admitted to use on at least 11 occasions in their
lifetime. Most of these recurrent users denied use of cocaine
within the 30 days before their CARDIA examination and may
not have used cocaine for years. Although we were able to
define alcohol consumption in terms of average weekly intake
in the year preceding the third examination, we were not able
to quantify duration of alcohol consumption at those levels.
Undoubtedly, not all of the CARDIA cohort classified as
heavy users were long-term alcohol abusers. Finally, cardiovascular sequelae, such as increased left ventricular mass, may be
dependent on both quantity of cocaine or alcohol consumed
and duration of heavy use. Because our study sample was
young, cocaine and alcohol use probably did not extend beyond
a decade or two. It is thus possible that cardiovascular effects
of continued long-term cocaine or alcohol consumption, or
both, in the CARDIA cohort might be demonstrable after
more sustained use.
Prevalence of substance use. A further limitation of this
study is that our categorization of alcohol and cocaine use was
based solely on self-report. Furthermore, the generalizability
of our findings could be affected by differences in substance use
patterns between CARDIA participants and other young
urban adults. We therefore compared alcohol and drug use
characteristics in the CARDIA study with those of other
samples to determine any differences in drug-use history. The
self-reported prevalence of abstinence, experimentation and
recurrent use of cocaine and alcohol in the CARDIA study is
similar to that found in other population-based surveys, such as
the Behavioral Risk Factor Surveillance Study (40) and the
National Household Survey (39). In specific analyses, the
lifetime use of alcohol in CARDIA participants was comparable to that of similarly aged respondents to the National
Household Survey on Drug Abuse (39). Lifetime use of
cocaine was higher in CARDIA participants; however, the
proportion of heavier cocaine use was similar. In the CARDIA
study, 43% of participants who admitted to ever using cocaine
reported using cocaine on >10 occasions in their lifetime
compared with 41% of 26 to 34-year old respondents interviewed in the 1990 National Household Survey on Drug Abuse
(39). In contrast to the National Household Survey, CARDIA
participants were recruited from large metropolitan areas
where a higher prevalence of illicit drug use is found compared
with areas with a lower population density (39). The prevalence of illicit drug use found in the longitudinal Harlem
Health Study was similar to that in the CARDIA study; in the
Harlem study 46% of 26 to 31-year old respondents (n = 411)
reported "nonexperimental" lifetime cocaine use, and 96%
any lifetime alcohol use (41). Thus, although underreporting of
cocaine or alcohol use, or both, by participants could potentially have biased our results toward the null, the generally
consistent reporting between the second and third examina-
900
HOEGERMAN ET AL.
COCAINE AND LEFT VENTRICULAR MASS
tions by participants and the similar prevalence of use between
CARDIA and other population-based studies makes this unlikely.
Conclusions. We found no consistent associations of left
ventricular mass with the levels of cocaine or alcohol use
reported by this group of healthy young adults. However, we
cannot conclude that alcohol and cocaine are not risk factors
for the development of cardiovascular complications if used
over longer periods of time or at different levels of consumption than reported by CARDIA participants. Further research
is needed to determine whether exposure thresholds exist for
these substances. However, the pattern of use prevalent in this
sample was not associated with left ventricular mass and
implies that cocaine and alcohol use may not be important
determinants of left ventricular mass in the young adult
population overall.
References
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