SERIES: DRUGS UNCOVERED: THE DOCTOR

Dr Chris Baker: 'When I See a Young Patient With a Heart Attack, One
of the First Things
I Think of Is Cocaine'

. Dr Chris Baker is an interventional cardiologist based at the
Imperial College Healthcare NHS Trust in London.

Different drugs affect your heart in different ways. Coke is probably
the one I see most because it causes premature coronary disease,
coronary spasm, chest pain and heart attacks.

Cocaine is a powerful stimulant with effects similar to adrenaline. It
reduces the re-uptake of noradrenaline and dopamine at nerve endings,
increasing blood pressure, making your heart beat faster and more
forcefully, and increasing the heart's oxygen demand. It can also
cause coronary arteries to spasm, reducing or stopping the heart's
blood supply, and makes the blood more sticky and likely to form
clots. All of those things can cause chest pain or a heart attack.

Using cocaine a lot seems to give you premature atherosclerosis -
that's the furring up of arteries normally associated with smoking and
cholesterol. Coke-related heart attacks are more common in people who
use cocaine a lot because they get this furring of the arteries, but
can it happen to someone who has taken cocaine as a one-off? Yes, it
can.

When I see a young patient with a heart attack, one of the first
things I think of is cocaine. If you're in your twenties or thirties
and you come in with a heart attack, I'll ask you: 'Have you been
doing coke?' And I'll probably dipstick your urine to find out. I'll
probably even consider it if you're in your forties.

I think people are quite honest. I'm not sure there's so much shame
about taking cocaine any more. It is so widespread that certain groups
of the population don't feel embarrassed about it.

Oddly, I've treated far more men than women, but that's probably a
function of the fact that men get more coronary heart disease than
women. In fact, I can't think that I've ever seen a woman with a
cocaine-related heart attack.

Cocaine leaves your system within about 48 hours, if you're not a
regular user. If you do use it regularly it hangs around that much
longer and it's possible that it could still be there for up to three
weeks. Of course, if you really want to test for it, it's in the hair.

I now see older people who are taking cocaine. We don't tend to ask
people in their fifties and sixties, but I bet there are plenty of
people of that age doing a bit of cocaine who have all the other risk
factors - cholesterol, high blood pressure, diabetes, smoking and so
on.

I think people are aware that if they do too much cocaine they'll lose
their nasal septum, but I don't think they're aware that it can affect
their heart.

I once came across a couple in their eighties who had been heroin
addicts for 35 years. They were very well off and bought very pure
heroin, they didn't use much so weren't escalating and they were very
meticulous about smoking the drug. If you're very careful you can go
on using it for years - although that clearly isn't the case for the
majority.