To the editor,
In Spain the number of cocaine seizures, requests for detoxification treatment and stated consumption of this drug is increasing every year. It has been estimated that 5% of students aged between 14 and 18 years old have consumed it,1 in addition to the fact that, from the cardiological standpoint, its use is worryingly associated with that of tobacco.2 In the Spanish hospital emergency service cocaine represents the leading cause of acute poisoning by illegal substances.3
We have read with great interest the excellent review by Sambola et al on the effect of coronary risk factors on endothelial dysfunction and their thrombotic complications.4 However, we were disappointed that cocaine consumption as a possible emerging vascular risk factor was not referred to, which in our experience probably should be added to the classic factors mentioned in the article.5,6
In addition to its acute effects at the coronary and, in general, cardiovascular levels,5,7 it has been suggested that cocaine consumption increases platelet aggregation,8-10 causes endothelial damage by increasing cell permeability to low-density lipoproteins11 and seems to contribute to atherosclerosis progression by increased expression of endothelial adhesion molecules and leukocyte migration.12 It is also possible that it increases the activity of plasminogen inhibitor activator.13 Recently, a relationship has been suggested between endothelial dysfunction, coronary artery calcification and high C-reactive protein values in chronic consumers.14 Coronary vasoconstriction, that occurs after cocaine consumption, may produce repeated injury to the arterial wall that could favor endothelial damage, thus serving as sites of platelet aggregation.6 As a probable result of these pathological mechanisms, and in support of the abovementioned idea, premature coronary arteriosclerosis has been identified in autopsies in young cocaine consumers.15
Although when chest pain occurs after its consumption the percentage of acute coronary events is relatively low (6%-12%),16,17 it may be worthwhile investigating the association between cocaine and chest pains in patients under 45 years old and, in particular, make health workers aware of the need to disseminate knowledge regarding this association and make consumers aware of the potential dangers of chronic consumption regarding the cardiovascular system.15,18