Abstract
Cocaine is a cardiotoxic drug which has been associated with morbi-mortality due to cardiovascular diseases (CVD). This study aims to: (1) analyze the hospitalizations due to cardiovascular processes and the presence of cocaine among the toxic habits of patients; and (2) discuss the forensic difficulties in sudden cardiac death (SCD) in the presence of cocaine. Hospital discharges due to CVD reporting cocaine consumption as a secondary diagnosis between 2003 and 2013 in Spain were analyzed. Subsequently, a review of judicial autopsies (SCD in cocaine users) was carried out to illustrate the forensic difficulties in the determination of the manner and underlying cause of death when cocaine use is involved. The average CVD morbidity rate was 1104.4 per 100,000 population. The most common main diagnoses of which cocaine use was recorded as a secondary diagnosis were rheumatic fever, ischemic heart disease and cerebrovascular disease in male patients between 15 and 44 years. The cardiovascular findings in the autopsies of cocaine users vary, and determining the mechanism that triggered the death in forensic practice is a challenge. The presence of cocaine among the toxic habits of young patients admitted for CVD in Spain is increasing. In our opinion, criteria must be unified to establish the manner and underlying cause of death in SCD and toxicological analysis can be a key part in the process.
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Abbreviations
- SCD:
-
Sudden cardiac death
- CVD:
-
Cardiovascular diseases
- ICD:
-
International Classification of Diseases
References
World Health Organization. (2017). Cardiovascular diseases (CVD). Fact Sheet.
Stankowski, R. V., Kloner, R. A., & Rezkalla, S. H. (2015). Cardiovascular consequences of cocaine use. Trends in Cardiovascular Medicine,25(6), 517–526.
Bachi, K., Mani, V., Jeyachandran, D., Fayad, Z. A., Goldstein, R. Z., & Alia-Klein, N. (2017). Vascular disease in cocaine addiction. Atherosclerosis,262, 154–162.
Finsterer, J., & Ohnsorge, P. (2013). Influence of mitochondrion-toxic agents on the cardiovascular system. Regulatory Toxicology and Pharmacology,67(3), 434–445. https://doi.org/10.1016/j.yrtph.2013.09.002.
Havakuk, O., Rezkalla, S. H., & Kloner, R. A. (2017). The cardiovascular effects of cocaine. Journal of the American College of Cardiology,70(1), 101–113.
Jiménez-Zarazúa, O., López-García, J. A., Arce-Negrete, L. R., Vélez-Ramírez, L. N., Casimiro-Guzmán, L., & Mondragón, J. D. (2018). Alveolar hemorrhage associated with cocaine consumption. Heart and Lung,47(5), 525–530.
Harris, A., & Walker, A. (2018). Interpretation of “Unnatural death” in coronial law: a review of the English legal process of decision making, statutory interpretation, and case law: The implications for medical cases and coronial consistency. Medical Law Review,27(1), 1–31.
Lucena, J., Blanco, M., Jurado, C., Rico, A., Salguero, M., Vazquez, R., et al. (2010). Cocaine-related sudden death: A prospective investigation in south-west Spain. European Heart Journal,31(3), 318–329.
Basso, C., Aguilera, B., Banner, J., Cohle, S., d’Amati, G., de Gouveia, R. H., et al. (2017). Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology. Virchows Archiv,471(6), 691–705.
Roth, G. A., Dwyer-Lindgren, L., Bertozzi-Villa, A., Stubbs, R. W., Morozoff, C., Naghavi, M., et al. (2017). Trends and patterns of geographic variation in cardiovascular mortality among US counties, 1980-2014. JAMA,317(19), 1976–1992.
López-Messa, J. B., Andrés-de Llano, J. M., López-Fernández, L., García-Cruces, J., García-Crespo, J., & Prieto González, M. (2018). Evolución de las tasas de hospitalización y mortalidad hospitalaria por enfermedades cardiovasculares agudas en Castilla y León, 2001-2015. Revista Espanola de Cardiologia,71, 95–104.
Royé, D., Zarrabeitia, M. T., Fdez-Arroyabe, P., Álvarez Gutiérrez, A., & Santurtún, A. (2018). Role of apparent temperature and air pollutants in hospital admissions for acute myocardial infarction in the North of Spain. Revista Espanola de Cardiologia. https://doi.org/10.1016/j.rec.2018.07.009.
Martins, S. S., Sampson, L., Cerdá, M., & Galea, S. (2015). Worldwide Prevalence and trends in unintentional drug overdose: A systematic review of the literature. American Journal of Public Health,105(11), e29–e49.
John, W. S., & Wu, L. T. (2017). Trends and correlates of cocaine use and cocaine use disorder in the United States from 2011 to 2015. Drug and Alcohol Dependence,180, 376–384.
Gill, J. R. (2017). From death to death certificate: What do the dead say? Journal of Medical Toxicology,13(1), 111–116.
Morentin, B., Ballesteros, J., Callado, L. F., & Meana, J. J. (2014). Recent cocaine use is a significant risk factor for sudden cardiovascular death in 15-49-year-old subjects: A forensic case-control study. Addiction,109(12), 2071–2078.
Palomo Rando, J. L., Ramos Medina, V., de la Cruz Mera, E., & López Calvo, A. M. (2010). Diagnóstico del origen y la causa de la muerte después de la autopsia médico-legal (Parte I). Cuad med forense,16(4), 217–229.
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Santurtún, A., García Blanco, A., Fdez-Arroyabe, P. et al. Cocaine in Hospital Admissions for Diseases of the Circulatory System and as the Underlying Cause of Death: Analysis and Discussion. Cardiovasc Toxicol 20, 20–27 (2020). https://doi.org/10.1007/s12012-019-09537-6
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DOI: https://doi.org/10.1007/s12012-019-09537-6