OBJECTIVES : Cocaine, the second most commonly used illicit drug, is highly addictive and widely abused. The purpose of this study was to review the acute and chronic effects of cocaine on the cardiovascular system with a specific focus on human studies.

METHODS : We searched PubMed and Cochrane Database of Systematic Reviews to identify studies published from September 2008 through September 2018. Full-text, original articles evaluating the effects of cocaine on the heart and vessels in humans were selected. From the selected articles, two reviewers independently extracted data on the study design, study population, data sources, study outcomes, results, and country that conducted the study.

RESULTS : A total of 18 articles meeting all inclusion criteria were reviewed. Studies have consistently reported the acute effects of cocaine (e.g., electrocardiographic abnormalities, acute hypertension, arrhythmia, and acute myocardial infarction) that occur through multifactorial mechanisms. However, studies have shown mixed findings on the chronic effects of cocaine. Some studies found no association between cocaine use and subclinical coronary artery disease (CAD), whereas others reported its association with subclinical coronary atherosclerosis. These inconsistent findings might be due to the heterogeneity of the study subjects with regard to cardiac risk. After cocaine use, populations at high risk for subclinical CAD experienced coronary atherosclerosis while those at low risk did not experience subclinical CAD, indicating that the chronic effects of cocaine were more likely to be pronounced among individuals with higher CAD risk. Studies also suggest that an individual’s risky behaviors, cardiovascular risks, and frequency of cocaine use may affect the association between cocaine use and mortality.

CONCLUSIONS : Prior studies have reported the deleterious effects of cocaine on the cardiovascular system. Compared to chronic effects, acute effects of cocaine have been particularly well-characterized. This finding highlights the need for education regarding its cardiotoxicity and access to effective interventions for cocaine abusers.