The Damaging Impact of Polysubstance Use on the Heart

New research has revealed problematic cardiac changes in patients with both cocaine and alcohol use disorders. This raises concerns about the effects of cocaine and alcohol use on the heart, even after treatment and abstinence.

“Cocaine use is a well-established cardiovascular risk factor, further enhanced by concurrent alcohol use. However, cardiovascular risk is poorly managed in individuals with cocaine use disorder,” wrote Porras-Perales, Segovia-Reyes, et al. in their cross-sectional case-control study on cardiac troponin alterations in patients with cocaine and alcohol use disorders.  

People with substance use disorder (SUD) frequently misuse more than one addictive drug, which is known as polysubstance use. This includes taking two or more together or within a short period, either intentionally or unintentionally.

“Whether intentional or not, mixing drugs is never safe because the effects from combining drugs may be stronger and more unpredictable than one drug alone, and even deadly,” explains a CDC webpage.

“While research indicates combined use of cocaine and alcohol poses [a] greater threat than either substance alone, there may be different mechanisms of injury,” explained Mark Gold, MD, in Psychology Today.

Researchers studied 84 participants with substance use. “Highly sensitive cardiac troponin T (cTnT) blood levels were measured. Cardiac troponin levels are markers for heart attack and other heart abnormalities. CTnT is a substance released into the bloodstream with damage to heart muscle. It includes troponin I (cTnI), a protein in heart muscle cells that regulates muscle contraction. The research showed distinct cardiac troponin blood alterations in cocaine addicts.”

When heart muscle is damaged during a myocardial infarction (heart attack), cTnI releases into the bloodstream. The major research finding was that cocaine use disorder patients showed significantly elevated cTnT levels relative to controls. In addition, patients with alcohol use disorder exhibited elevated cTnI levels relative to controls.

“This suggests possible subclinical myocardial injury caused by cocaine distinct from alcohol’s effects,” wrote Dr. Gold. “Sadly, even with abstinence and without overt cardiovascular disease, substance use disorders (especially cocaine) are associated with detectable and important heart and injury signals.”

The new study is a reminder that among drug combinations, cocaine (and methamphetamine) is a well-established cardiovascular risk factor. “The combined use of methamphetamine/cocaine plus alcohol may cause cardiovascular disease (CVD) problems so often that when addiction treatment begins in early abstinence, physicians should consider a cardiovascular risk assessment,” explained Dr. Gold.

“Chronic heavy alcohol use has a direct negative effect on the heart, referred to as myocardial toxicity. This causes cardiomyopathy, arrhythmias, and hypertension. In the Porras‑Perales et al. study described at the beginning of this post, researchers found that alcohol use was associated with elevated cTnI, suggesting subclinical injury.”

Chronic alcohol use contributes to dilated cardiomyopathy, atrial fibrillation, left ventricular dysfunction, and increased heart failure risk.

NRT Behavioral Health programs take a comprehensive approach to treating Substance Use Disorder.

Our programs provide modern, evidence-based addiction treatment and integrated addiction medicine to address the needs of the patient as a whole person. Many individuals suffering from prolonged substance use disorder and who use multiple substances have increased risks for complex medical problems, such as heart conditions.

Our experienced medical team members are experienced at identifying comorbid health conditions accompanying long-term substance misuse and can refer clients to appropriate specialized treatment. Treating comorbidities is crucial for maintaining lasting health and promoting recovery. Unless chronic conditions are treated, people may experience a range of debilitating symptoms that prevent them from feeling well and sustaining their recovery.

NRT Behavioral Health residential treatment programs, Foundry Front Range, and Foundry Steamboat provide the level of comprehensive assessment and treatment needed to successfully diagnose and create treatment plans to find and treat heart problems and other healthcare problems associated with substance use disorders.

If you or a loved one needs help, please get in touch with our informed admissions team at (720) 807-7867.