Cocaine use disorder and risk of acute coronary syndromes in adults with unhealthy drinking

Cocaine use disorder (CUD) is a significant public health issue, and cocaine's common pairing with alcohol has been linked to adverse cardiovascular outcomes. Among adults with unhealthy alcohol use, we investigated whether co-occurring CUD was associated with excess risk of acute coronary syndrome (ACS). We retrospectively studied 413,511 adults in Northern California from June 1, 2013 to December 31, 2022, with documented unhealthy alcohol use, defined as exceeding either the daily limit and/or weekly drinking limits recommended by the U.S. National Institute of Alcohol Abuse and Alcoholism (NIAAA) guidelines. Using health system electronic health record (EHR) data, concomitant CUD was ascertained from ICD-9/10 diagnosis codes, and alcohol consumption from patient self-report on screening questionnaires. During a follow-up period of up to 9.5 years, ACS was defined as a primary hospital discharge ICD-9/10 diagnosis code for unstable angina or myocardial infarction with elevated cardiac troponin I. Logistic regression evaluated the association of concomitant CUD and alcohol consumption levels with ACS. Models were adjusted for demographic, socioeconomic, and clinical covariates, including cardiovascular risk factors. The prevalence of CUD diagnoses was 0.6%, and 12.4% of the cohort exceeded both daily and weekly drinking limits. CUD was not significantly associated with ACS (adjusted odds ratio [aOR] = 1.27 [95% CI: 0.94-1.73]). Patients who exceeded daily and weekly drinking limits had higher odds of ACS, compared to those who exceeded only daily limits (aOR = 1.20 [95% CI: 1.12-1.28, p < .001). Among adults with unhealthy alcohol use, diagnosed CUD was not significantly linked to ACS. The heaviest drinking pattern was associated with a modestly higher adjusted risk of ACS.