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.

Public Health Relevance

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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA037012-05
Application #
9527789
Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Chand, Naresh
Project Start
2014-08-01
Project End
2019-07-31
Budget Start
2018-08-01
Budget End
2019-07-31
Support Year
5
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94118
Meacham, Meredith C; Ramo, Danielle E; Kral, Alex H et al. (2018) Associations between medical cannabis and other drug use among unstably housed women. Int J Drug Policy 52:45-51
Kim, Jin E; Flentje, Annesa; Tsoh, Janice Y et al. (2017) Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity. J Urban Health 94:514-524
Young, Dmitri A; Shumway, Martha; Flentje, Annesa et al. (2017) The relationship between childhood abuse and violent victimization in homeless and marginally housed women: The role of dissociation as a potential mediator. Psychol Trauma 9:613-621
Riley, Elise D; Hsue, Priscilla Y; Vittinghoff, Eric et al. (2017) Higher prevalence of detectable troponin I among cocaine-users without known cardiovascular disease. Drug Alcohol Depend 172:88-93
van Wijk, Xander M R; Vittinghoff, Eric; Wu, Alan H B et al. (2017) Cocaine use is associated with a higher prevalence of elevated ST2 concentrations. Clin Biochem 50:791-793
Riley, Elise D; Kral, Alex H; Cohen, Jennifer et al. (2016) Levamisole-Contaminated Cocaine Use in HIV-Infected and Uninfected Unstably Housed Women. J Womens Health (Larchmt) 25:936-43
Riley, Elise D; Evans, Jennifer L; Hahn, Judith A et al. (2016) A Longitudinal Study of Multiple Drug Use and Overdose Among Young People Who Inject Drugs. Am J Public Health 106:915-7
Riley, Elise D; Shumway, Martha; Knight, Kelly R et al. (2015) Risk factors for stimulant use among homeless and unstably housed adult women. Drug Alcohol Depend 153:173-9