Cocaine and Alcohol Co-Use in Unstably Housed Women Increases Stroke Likelihood

Women experiencing homelessness and unstable housing who have cocaine and alcohol co-use are more likely to experience stroke, according to study findings published in Stroke.

Investigators examined the association between polysubstance use, particularly stimulant use, and stroke in women who have homelessness and unstable housing.

The investigators conducted an observational cohort study recruiting women from community-based venues in San Francisco who experienced homelessness and unstable housing. Electronic health records (EHRs) from participants in the Polysubstance Use and Health Outcomes Evaluation study were used across the study period from June 2016 to January 2019, consisting of 6 consecutive monthly study visits. Participants were reimbursed $40 for each study visit. Associations with baseline study factors that included toxicology-confirmed use of multiple substances, social determinants of health, and traditional stroke risk factors were evaluated, and EHRs were reviewed for up to 2 years after initial study completion.

Overall, 238 participants were included in the analysis (median age, 53.4 [IQR, 45.4-59.4] years; 38.7% Black; 28.6% White) among whom 37.4% had experienced homelessness in the past month and 49.0% had moderate-to-severe depression. The most commonly detected substance use was for nicotine (69.3%), cocaine (52.5%), cannabis (50.8%), amphetamines (31.1%), alcohol (28.2%), and opioids other than fentanyl or heroin (24.4%). Cocaethylene (a biomarker signaling alcohol and cocaine concurrent co-use) was found in 17.2% of patients.

Participant median body mass index was 27.8; 15.1% were diagnosed with diabetes; 54.2% had history of hypertension, heart failure, or blood clots; 11.8% had prior self-reported stroke; and 31.1% had HIV.

Overall, 3.8% had strokes during the study period. Cocaethylene was associated with stroke (odds ratio, 3.22; 95% CI, 1.02-10.20) after adjusting for age, hyperlipidemia, and opioid use. Among participants experiencing stroke, 2 were taking antihypertensive medication and none were taking a statin.

Study limitations include a small sample size and single-site design limiting generalizability. Documented strokes were determined at a single hospital, and documented strokes at other hospitals were missed and not included in analysis. Additionally, no differentiation was made concerning the type of stroke or cause of stroke, and strokes were not adjudicated (the influence of adjudication on findings was unclear).

“Cocaethylene and opioids were strongly associated with stroke among women who experience homelessness and unstable housing,” the investigators concluded, suggesting, “…women reporting cocaine and alcohol co-use should be counseled about the especially harmful effects of this substance combination on their cerebrovascular health.”

This article originally appeared on The Cardiology Advisor