Cracking the Role of Cocaine in Stroke

See related article, p 918. Cocaine is widely assumed to be a risk factor for stroke, yet good scientific evidence for a causal association between the use of cocaine and ischemic stroke is not as clear as commonly held. Cocaine use is widespread. In 2013, an estimated 24.6 million Americans, ≈9% of the population aged ≥12 years, had used an illicit drug in the past month.1 Although the majority was using marijuana, past month cocaine intake was still reported by 1.5% of the US population.1A similarly high use of cocaine was also found in a population-based case–control study by Cheng et al2 reporting, in this issue of Stroke , on the association of cocaine exposure and risk of ischemic stroke, from “The Stroke Prevention in Young Adults Study.” In their study population, derived from the greater Baltimore/Washington DC area, a quarter of subjects with recent ischemic stroke (cases), between the 15 and 49 years of age, were found to have previously used cocaine. An equally high prevalence of having ever used cocaine was recorded in an age-, sex-, race- and geographically matched control group of stroke-free subjects. Subjects with stroke, however, were more likely to have used cocaine more than once per week in the past year and the odds of having used cocaine in the 24 hours before stroke onset was ≈6× higher in cases, when compared with a reference date for controls. This led the authors to conclude that the risk of ischemic stroke is highest in the first …