Cocaine Worsens Heart Disease (Atherosclerosis): Whitney Houston Case

“The handwriting was on the wall,” says sister-in-law Patricia of pop star legend Whitney Houston’s death by accidental drowning — with cocaine use and heart disease listed as contributing factors.

It had been possible to forecast that drugs would claim the singer’s life, she told the Agence France Presse after a coroner’s report released on March 22 showed that drowning was the main cause of Houston’s death — but that this was aggravated by atherosclerotic heart disease, that in turn was worsened by her chronic cocaine use.

Houston was found dead in a Beverly Hilton Hotel bathtub on February 11, a day before the Grammy Awards and hours ahead of a glittering pre-awards party in the hotel where she died.

A public prayer and several tributes to the singer were added at the last minute to the annual gathering, after her sudden death cast a pall over the music industry’s biggest awards event.

A sensation from the time her first, eponymous album was released in 1985, Houston was one of the world’s best-selling artists from the mid-1980s to the late 1990s. She sold over 170 million records during in her career, which spanned almost three decades — churning out such hits as “I Wanna Dance With Somebody,” “How Will I Know,” “The Greatest Love of All” and “I Will Always Love You.” But the pop star also fought a long battle against substance abuse and as she struggled, her phenomenal voice became raspy and she couldn’t hit the high notes.

While she was last reported to have checked into rehab in May 2011, she was seen drinking heavily and behaving erratically in the three or four days before her death, according to celebrity media.

A week after her death, Houston was laid to rest in New Jersey in an emotional burial at the Newark Baptist church where she sang as a child, in a ceremony that was beamed to television screens across the world.

Houston’s death a heart event
Ending weeks of speculation about the cause of her death, the Los Angeles county coroner released an official statement on March 22, saying that Houston death was an “accident” caused by “drowning” and the “effects of atherosclerotic heart disease and cocaine use.” The 48-year-old singer had cocaine in her body when she died, the report said.

“You have a heart condition exacerbated by cocaine use which, combined, resulted in her drowning,” LA department of coroner chief Craig Harvey told AFP, adding: “We feel that there was a heart event, complicated by cocaine use,” before she drowned.

Ed Winter, deputy chief of coroner investigations, was more explicit. “She may have had a heart attack,” he told the Los Angeles Times.

A final coroner’s report will be released within two weeks, but the latest findings were: “How injury occurred: found submerged in bathtub filled with water; cocaine intake.” “No trauma or foul play is suspected.”

Since her death, speculation had raged that the singer might have succumbed to a lethal cocktail of prescription drugs and alcohol. And while other drugs were found in her system — diphenhydramine (Benadryl), cyclobenzaprine (Flexiril), alprazolam (Xanax) and marijuana — the coroner’s office said these didn’t contribute to her death.

Investigators who arrived on the scene found also no traces of cocaine or any other illegal drug, but the coroner’s office affirmed that Houston used cocaine “immediately prior to her collapse.” “An individual” had removed all traces of cocaine from the room before authorities arrived, the report surmised. This person was the same one who supplied the drug to Houston, the report said.

Cardiac event from atherosclerosis
“Chances are, had she (Houston) not had the pre-existing heart disease and cocaine use she may not have drowned,” coroner Harvey said at a press conference. “Cocaine causes the heart to beat faster, the arteries to constrict, which could… set you up for a cardiac event.”

What’s more, cocaine use has been known to cause damage to the heart — in the first place, Dr. Michael Fishbein pathology professor at the University of California in Los Angeles David Geffen School of Medicine told the Associated Press. He had no role in the investigation. “There’s no reason to drown in a bathtub unless you’re incapacitated,” Dr. Fishbein added.

More tellingly, Harvey said that Houston’s arteries showed 60 percent narrowing — suggesting “a cardiac event complicated by the cocaine use” that led to Houston’s slipping underwater. “Something happened that caused her to go down and we know that when she slipped under the water she was still alive,” he said. “We have evidence of drowning since there was water in the lungs.”

Cocaine worsened heart condition
“Cocaine, like other stimulants, can exacerbate pre-existing heart disease, such as coronary artery disease or hypertension. In the presence of these pre-existing diseases, cocaine can cause heart failure, heart attack or sudden death,” a spokeswoman for the San Diego, California County Medical Examiner’s Office told the press. But spokeswoman Sarah Gordon stressed she wasn’t saying that this was exactly what happened to Houston.

Health experts also say the chronic use of cocaine can accelerate the development of atherosclerosis — the formation of plaque inside blood vessels — even in young people. Eventually, plaque buildup can lead to severe narrowing of the vessels, causing heart attack, stroke, or a transient ischemic attack — a TIA or so-called “ministroke.”

A ministroke can leave you disoriented, cause fainting, and falls — and if one happens to be in a bathtub at the time it could lead to a fatal drowning.

“Ischemic stroke/TIA is also a common neurovascular presentation in patients with a remote history of cocaine use, often as a result of atherosclerotic disease,” Vitals on quotes a University of California San Francisco study.

According to Vitals, bits of plaque can also break off and block a vital vessel, also causing a heart attack or stroke after exercise, trauma, getting the rush of nicotine from smoking a cigarette, or taking cocaine — as Whitney Houston did. Even hot water can trigger this.

A 1991 study of 151 drowning and hyperthermia deaths in spas, Jacuzzis and hot tubs found that in 14 percent of them, cocaine — with or without alcohol ingestion — was implicated as a contributing factor, said.

Chronic cocaine use contributes to atherosclerotic heart disease
A condition in which plaque hardens in the arteries and narrows them — that’s atherosclerotic heart disease, the National Heart Lung and Blood Institute explains.

Narrowed arteries — like that found in Houston — can lead to serious problems including heart attack, stroke and death. This is because it limits the flow of oxygen-rich blood to the organs and other parts of the body.

Atherosclerosis can develop into coronary heart disease — the No. 1 killer of American men and women. It can also cause carotid artery disease, peripheral arterial disease and chronic kidney disease.

A number of factors — poor diet, infrequent exercise or alcohol abuse — can cause heart disease. And chronic cocaine use can worsen the condition. Multiple areas of scarring within the arteries and heart happen when blood vessels are repeatedly exposed to the drug’s chemical make-up, doctors say.

According to Mayo Clinic, the symptoms of atherosclerosis can be hard to spot, since mild atherosclerosis typically doesn’t have any signs. But if the arteries are seriously clogged and hardened, the blood clot that forms in the artery can break — leading to a heart attack or stroke.

“The build of plaque in the heart tends to occur slowly over the years,” Dr. Phil Ragno, director of cardiovascular health and wellness at Winthrop Hospital told “It builds up like layers of an onion, so what happens is when enough of the artery is narrowed down it can cause symptoms or even a heart attack.”

Meanwhile, cocaine use increases heart rate, blood pressure and causes the blood vessels to constrict — reducing the supply of blood to the heart. So when a person uses cocaine on top of suffering from advanced atherosclerotic heart disease — as Houston had — the impact on the heart can be devastating.

“(Cocaine use) puts extra demand on the heart while at the same time restricting blood supply to the heart,” Dr. Ragno said. “So at the time when the heart needs the most amount of blood, it’s getting the least amount of blood.” In some cases, the addict may experience a heart attack or fatal heart arrhythmia.

“Cocaine works in two ways—as a stimulant and anesthetic,” Dr. Ragno explained. “As an anesthetic, it blocks some of the channels in the heart that move electrolytes such as sodium and potassium. This raises the risk of suffering from an irregular heartbeat or arrhythmia.”

“If you use cocaine chronically, it will have a deleterious effect on the heart without a doubt,” Dr. Nicholas Kardaras, an addiction specialist and clinical professor at the Health Sciences Center of Stony Brook University in Stony Brook, N.Y. also told the media.

While it’s impossible to say how many addicts suffer from heart problems, he said “it’s fair to say a significant percentage of people have a long-term history of cocaine use do.”

“How serious the condition is depends on other risk factors, such as diet and exercise [frequency], and how much cocaine you’ve been taking and for how long, among other factors,” he concluded.

The plaques of atherosclerosis cause the three main kinds of cardiovascular disease:

Coronary artery disease. This happens when stable plaque in the heart’s arteries cause angina or chest pain on exertion. Heart muscles die when plaque ruptures suddenly and clotting happens — this is a heart attack, or myocardial infarction.

Cerebrovascular disease. Ruptured plaque in the brain’s arteries can cause strokes that can damage the brain permanently. Temporary blockages in an artery can also cause transient ischemic attacks (TIAs) — warning signs of stroke but without brain injury.

Peripheral artery disease. This is the narrowing in the arteries of the legs caused by plaque. Peripheral artery disease causes poor circulation, making walking painful and healing of wounds longer. Amputations may result from severe disease.

Can I prevent myself from getting atherosclerosis?

Yes of course. First off, stay away from drugs. According to the NHLBI, you can prevent yourself from acquiring the heart condition by not smoking, keeping a healthy weight and a healthy level of blood pressure, lowering cholesterol intake and not allowing yourself to develop diabetes type 1.

But there are some factors that you can’t change. As people grow older, they also get a higher risk for plaque development — generally, this includes men who are older than 45 years and women above 55 years. You are also more prone to have CAD if you have a family history for early heart artery disease.

Who can get atherosclerosis?

According to WebMD, it might be easier to ask, who doesn’t get atherosclerosis? This is because the condition starts early and affects a huge chunk of the world’s population. Autopsies of young American soldiers killed in action in the Korean and Vietnam wars showed that up to three-fourths had early forms of atherosclerosis. A more recent study done in 2001 on 262 apparently healthy people’s hearts showed that:

• 51.9 percent had some atherosclerosis
• Atherosclerosis was present in 85 percent of those older than 50
• 17 percent of teenagers had atherosclerosis

If you are 40 and generally healthy, according to WebMD, you have about a 50 percent chance of developing serious atherosclerosis in your lifetime — and the risk goes up as you get older. Most people older than 60 have some atherosclerosis but often don’t have noticeable symptoms.

But deaths from atherosclerosis have fallen by 25 percent since 30 years ago — thanks mainly to improved treatments.

How is atherosclerosis diagnosed?
Typically, your doctors will combine an electrocardiogram or EKG with exercise treadmill tests to screen you — especially if you have a moderate chance of significant atherosclerosis. Together, these two procedures are about 60 to 70 percent accurate.

If the stress tests don’t reveal the diagnosis, atherosclerosis can be identified more accurately with nuclear imaging. This is done by adding a nuclear agent — thallium or Cardiolite — intravenously during stress tests. The thallium allows nuclear imaging of the blood flow to different regions of your heart and significant narrowing of your arteries can be detected.

The most accurate way to detect coronary artery narrowing is by testing with what’s known as coronary arteriography. In this test, small catheters or hollow plastic tubes are advanced to the openings of the two main heart arteries, under x-ray guidance. An x-ray video is then recorded as iodine contrast “dye” is injected into the arteries. Sometimes, an exercise study is then done to determine whether a moderate narrowing of 40- 60 percent is actually causing ischemia, requiring treatment.

Another very accurate way to detect severe atherosclerosis is to combine echocardiography — or ultrasound imaging of the heart muscle — with exercise stress testing or stress echocardiography. When the heart muscle supplied by an artery doesn’t contract as well as the rest of the heart muscle, a significant blockage exists. Stress echocardiography and thallium stress tests are both at least 80- 85 percent accurate in detecting significant coronary artery disease.

How is atherosclerosis treated?
Sadly, once a blockage in your blood vessels is there, it’s generally there to stay. But with medications and lifestyle changes, plaques may stop growing or at least grow at a slower rate. With aggressive treatment, they may even shrink slightly.

Lifestyle changes include: healthy diet, exercise and no smoking
Medication includes: Taking drugs for high cholesterol and high blood pressure will slow and perhaps even halt the progression of atherosclerosis, as well as lower your risk of heart attacks and stroke.

Invasive techniques include:

Angiography and stenting. The most common angiography procedure performed is cardiac catheterization with angiography of the coronary arteries. In this treatment, a thin tube is inserted into an artery in the leg or arm so that doctors can access diseased arteries. Blockages are visible on a live X-ray screen. Then a small balloon is inserted with a catheter and used to inflate the blockage in your artery. A stent is often also put to keep the artery open.

Bypass surgery. In this procedure, surgeons “harvest” a healthy blood vessel — usually from the leg or chest– and they use this healthy vessel to bypass a segment blocked by atherosclerosis.
These procedures involve a risk of complications. They are usually saved for people with significant symptoms or limitations caused by atherosclerosis.