title: Cocaine Abstinence and Reduced Use Associated With Lowered Marker of Endothelial Dysfunction in African Americans: A Preliminary Study.
abstract: OBJECTIVE
  Clinical and epidemiological evidence suggests that cocaine use is associated with an increased risk of premature atherosclerosis. The objectives of this study were to explore (1) whether cocaine abstinence is associated with a reduced marker of endothelial dysfunction, (2) whether cocaine abstinence is associated with a slower coronary plaque progression, and (3) whether reduction in cocaine use is associated with a reduced marker of endothelial dysfunction in African American chronic cocaine users with contrast-enhanced coronary CT angiography-confirmed less than 50% coronary stenosis.
  
  
  METHODS
  Between March and June 2014, a total of 57 African American cocaine users with contrast-enhanced CT angiography-confirmed less than 50% coronary stenosis in Baltimore, Maryland, were enrolled in a 6-month follow-up study to investigate whether cocaine abstinence or reduction in cocaine use is associated with decreased endothelin-1 (ET-1) levels and coronary plaque progression at the 6-month follow-up. A voucher-based incentive approach was used to systematically reinforce cocaine abstinence, and urine benzoylecgonine test was implemented to confirm cocaine use.
  
  
  RESULTS
  Among the 57 participants, 44 were HIV-infected. The median of duration of cocaine use was 18 (interquartile range, 7-30) years. According to generalized estimating equation analyses, both cocaine abstinence and reduction in cocaine use in the 6 months were independently associated with decreased ET-1. The incidence of coronary plaque progression was 7.4/100 person-years and 23.1/100 person-years in those who were totally abstinent from cocaine and those who continued to use cocaine, respectively. However, the difference in the incidence between these 2 groups was not significant (exact P = 0.30).
  
  
  CONCLUSIONS
  The findings of this study revealed a possible association of cocaine abstinence/reduction with lowered ET levels, which suggests that such changes in cocaine use might be beneficial for preventing endothelial damage. Further studies should be conducted to investigate whether ET-1 could be used as a marker for cocaine abstinence and reduction in cocaine use.
authors.affiliation: From the Department of Radiology and Radiological Science (HL, EL, SL), Department of Psychiatry (MS, GT, SL), Department of Medicine (RM, JB, GG, SL), and Department of Pathology (TSK, JL, SC, SL), Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Hong
authors.initials: H
authors.lastname: Lai
authors.forename: Maxine
authors.initials: M
authors.lastname: Stitzer
authors.forename: Glenn
authors.initials: G
authors.lastname: Treisman
authors.forename: Richard
authors.initials: R
authors.lastname: Moore
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brinker
authors.forename: Gary
authors.initials: G
authors.lastname: Gerstenblith
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Kickler
authors.forename: Ji
authors.initials: J
authors.lastname: Li
authors.forename: Shaoguang
authors.initials: S
authors.lastname: Chen
authors.forename: Elliot
authors.initials: E
authors.lastname: Fishman
authors.forename: Shenghan
authors.initials: S
authors.lastname: Lai
mesh_terms: D000328:Adult; D001741:Black or African American; D015415:Biomarkers; D019970:Cocaine-Related Disorders / Q000097:blood / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D019332:Endothelin-1 / Q000097:blood*; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011859:Radiography; D014652:Vascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000517:prevention & control*
chemical_list: D015415:Biomarkers; D019332:Endothelin-1