Cocaine use and risk of stroke: A systematic review☆

7 de agosto de 20146min2

Drug and Alcohol Dependence

L. Sordo, B.I. Indave, G. Barrio, L. Degenhardt, L. de la Fuente, M.J. Bravo


•Data support the biological plausibility of cocaine as possible stroke risk factor.
•A systematic review was conducted to identify relation between cocaine and stroke.
•Epidemiological evidence suggests cocaine increases risk of stroke.
•More research on this causal relation is warranted to affirm cocaine causes stroke.
•Well-designed cohort studies in young-to-middle age population are needed.




Both cocaine use and strokes impact public health. Cocaine is a putative cause of strokes, but no systematic review of the scientific evidence has been published.


All relevant bibliographic-databases were searched until January 2014 for articles on the epidemiological association between cocaine use and strokes. Search strings were supervised by expert librarians. Three researchers independently reviewed studies for inclusion and data extraction following STROBE recommendations. Quality appraisal included study validity and bias. Both ischemic and hemorrhagic strokes were considered.


Of 996 articles, 9 were selected: 7 case–control studies (CCS) and 2 cross-sectional (CSS) studies. One CCS (aOR=6.1; 95% CI: 3.3–11.8) and one CSS (aOR=2.33; 95% CI: 1.74–3.11) showed an association between cocaine and hemorrhagic strokes. The latter study also found a positive relationship with ischemic stroke (aOR=2.03; 95% CI: 1.48–2.79). Another CCS found the exposure to be associated with stroke without distinguishing between types (aOR=13.9; 95% CI: 2.8–69.4). One forensic CCS found that deaths with cocaine-positive toxicology presented a 14.3-fold (95% CI: 5.6–37) and 4.6-fold (95% CI: 2.5–8.5) increased risk of atherosclerosis compared to opioid-related deaths and hanging-deaths respectively. One CCS did not provide an aOR but found a statistically significant association between cocaine and hemorrhagic stroke. Three CCS and one CSS did not find any relationship between cocaine and strokes. Inadequate control for confounding was not uncommon.


Epidemiological evidence suggests that cocaine use increases the risk of stroke. Larger, more rigorous observational studies, including cohort approaches, are needed to better quantify this risk, and should consider stroke type, hypertension variation, frequency/length of cocaine use, amphetamines co-use, and other factors.

Keywords: Cocaine, Crack, Strokes, Cerebrovascular accidents, Systematic review


Sobre a UNIAD

A Unidade de Pesquisa em álcool e Drogas (UNIAD) foi fundada em 1994 pelo Prof. Dr. Ronaldo Laranjeira e John Dunn, recém-chegados da Inglaterra. A criação contou, na época, com o apoio do Departamento de Psiquiatria da UNIFESP. Inicialmente (1994-1996) funcionou dentro do Complexo Hospital São Paulo, com o objetivo de atender funcionários dependentes.


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