The recent sudden death of Len Bias, former University of Maryland basketball star, and the possibility that cocaine was a contributor, has put the spotlight on the relationship between cocaine and its effects on the heart.
Cardiologists Mark Estes and Jeffrey Isner of the New England Medical Center, which is affiliated with Tufts University near Boston, have released a study suggesting that cocaine affects the heart in a life-threatening manner.
The study, the largest of its kind, offered some answers in light of reports that Bias, the Boston Celtics' first-round draft pick, had used the drug shortly before his death last Thursday.
Seven patients, between 20 and 37, were part of the study, which was conducted in 1984-1985. All seven had used cocaine within six hours of being taken to the hospital with heart difficulties and none had shown previous signs of heart disease. Of the seven:
--Four patients had heart attacks and one of them died.
--One patient had severe scarring of the heart muscle, which improved after six months of medication and complete abstinence from cocaine.
--Two patients had ventricular arrhythmias--unstable heart rhythms resulting in rapid heartbeats and ineffective pumping of blood. One of those patients--a chronic user--was found dead.
"He was found dead in bed and had been using (cocaine) several times a week for at least two years," said Estes, director of the Cardiac Electrophysiology Laboratory at the hospital.
In light of the study, if Bias used cocaine just before his death, as preliminary reports indicate, his death can't be considered altogether surprising.
Declining to comment specifically on the Bias case, Estes nevertheless said: "In other young patients who had been free of heart disease, we clearly have seen serious heart problems that had been associated with the use of cocaine."
Estes said that being an athlete would not necessarily decrease the chances of heart failure in a cocaine user.
"We have no medical information about it, but there's not any reason to believe that being an athlete would make you more or less sensitive to cocaine," Estes said. One of the patients in the study was a judo instructor.
"In general, as one gets older, the risk of having adverse heart attacks from cocaine would get higher because in an older population of patients, there's more frequently blockages in the arteries of the heart," Estes said. "But it's not generally an old population that uses cocaine."
Estes and Isner couldn't say for sure that a first-time user would be at less or greater risk, but Isner did say: "Some of our patients alleged that they had not used the drug before, but that can't be historically documented."
Cocaine stimulates the flow of adrenaline to the heart, which doctors say causes stress on the heart. For the patients in the study, cocaine apparently acted as a catalyst for their heart problems.
Besides increasing blood pressure and the heart rate, cocaine taken through the nostrils--all seven of the patients studied had sniffed cocaine--causes the blood vessels in the nose to constrict.
Doctors are also looking at the possibility of the drug having the same effect on the arteries, thus leading to further heart problems.
"We have a black box (unanswered questions) about this drug. . . . It has not been systematically evaluated medically," Estes said. "It's (just) not a safe drug."