Use of stimulant drugs may be linked to a higher risk for stroke

The use of stimulant drugs, including cocaine and amphetamines, may be linked to a higher risk for stroke, according to a report in the April issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"Evidence has been accumulating for two decades supporting a link between abuse of stimulant drugs and strokes in young people," the authors write as background information in the article. Cocaine, amphetamines and other stimulants may increase the risk of stroke by raising blood pressure or contributing to narrowing blood vessels by triggering spasms in the vessel walls.

Arthur N. Westover, M.D., of The University of Texas Southwestern Medical Center at Dallas, and colleagues used a database of 3,148,165 discharges from Texas hospitals between 2000 and 2003 to assess the connection between drug use and strokes. Strokes and drug dependence or abuse were identified by clinical codes.

In the four-year period, there were 8,369 strokes: 1,887 in 2000, 2,097 in 2001, 2,133 in 2002 and 2,252 in 2003. Cocaine was the second most frequently abused drug after alcohol, and amphetamines were the fifth; abuse of both, as well as cannabis and opioids, increased significantly.

In 2003, the only year that codes identified the difference between hemorrhagic (bleeding within the brain) and ischemic (blocked blood flow to the brain) strokes, amphetamine abuse was associated with a five-fold greater risk of hemorrhagic stroke but not ischemic stroke. Cocaine abuse was associated with more than double the risk of both hemorrhagic and ischemic stroke. "Amphetamine, but not cocaine, abuse was associated with a higher risk of death after hemorrhagic stroke," the authors continue.

"The public health implications of these findings are heightened by growing news accounts suggesting a recent increase in methamphetamine abuse, particularly in the southwestern, western and Midwestern states," they conclude. "This concern was supported by our finding that, among hospitalized patients in Texas from 2000 to 2003, the rate of amphetamine abuse was increasing faster than that of any other drug, including cocaine, and the rate of strokes among amphetamine abusers was increasing faster than the rate of strokes among abusers of any other drug."