Cocaine use leads to 64,000 acute health care visits every year and is the most frequent cause of overdose mortality reported by medical examiners. Unstably housed women have among the highest rates of cocaine use, which is consistently linked to increasing rates of death. The proposed study will investigate the combined influences of HIV, illicit drug use, legal drug use (i.e., alcohol, tobacco and caffeine) and prescription dru use on cardiac health to provide clinical tools for risk assessment and reduce overdose mortality.
Observations from a recently completed homeless women's cohort study indicated that acute intoxication in which cocaine was detected at autopsy was the most common cause of death. This finding follows a national trend of increased overdose deaths. According to the San Francisco Medical Examiner, at least one-third of cocaine-related deaths among San Francisco women are directly linked to a cardiovascular event. While independent influences of both cocaine use and HIV infection on cardiac dysfunction have been described, combined effects and influences from polysubstance use are unclear. Such information could be used to address subclinical cardiac dysfunction prior to infarction and sudden death. Here we propose a multi- disciplinary study to understand the circumstances preceding acute drug-induced cardiovascular events among homeless women. We hypothesize that HIV, polysubstance use and concomitant medications influence chronic drug toxicity and subclinical cardiac injury. To meet our aims, the study will obtain interview data, echocardiograms and specimens for biomarker assessment among 250 homeless and unstably housed women (125 HIV+ and 125 HIV-). Results from the proposed study will provide enhanced clinical tools for risk assessment and risk stratification among cocaine users, as well as clarify endpoints for future pharmacological and behavioral interventions.