Effects of polydrug use, adulterants and HIV on cardiac injury in homeless women

多种药物使用、掺假物和艾滋病毒对无家可归妇女心脏损伤的影响

• 批准号: 8728551
• 负责人: ELISE D. RILEY
• 金额: $ 72.54万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8728551
• 关键词: AIDS/HIV problem; Accounting; Acute; Address; Age; Alcohols; Autopsy; Behavior Therapy; Biological Assay; Biological Markers; Breathing; Caffeine; Cardiac; Cardiovascular system; Case Study; Cause of Death; Cessation of life; Chest Pain; Chronic; Chronic Disease; Clinical; Clothing; Cocaine; Cocaine Users; Cohort Studies; Communities; Comorbidity; Coronary heart disease; Cross-Sectional Studies; Data; Death Rate; Development; Drug abuse; Drug toxicity; Drug usage; Drug user; Echocardiography; Event; Food; Frequencies; Functional disorder; Future; Goals; Gold; Guidelines; HIV; HIV Infections; Hair; Health; Health Care Visit; Healthcare; Heart; Homelessness; Hygiene; Illicit Drugs; Immune; Individual; Infarction; Injury; Interruption; Interview; Intoxication; Legal; Levamisole; Link; Measures; Medical; Medical Examiners; Morbidity - disease rate; Myocardial; Myocardial Infarction; Nicotine; Outcome; Overdose; Persons; Pharmaceutical Preparations; Population; Prevalence; Race; Recruitment Activity; Reporting; Risk; Risk Assessment; Role; San Francisco; Seizures; Shelter facility; Specimen; Stratification; Sudden Death; Surveys; Symptoms; Time; Tobacco; Toxic effect; Toxicology; Troponin; Troponin I; Ventricular Dysfunction; Vulnerable Populations; Woman; antiretroviral therapy; cardiovascular risk factor; cocaine use; cohort; effective therapy; follow-up; housing instability; meetings; mortality; overdose death; public health relevance; response; social; standard measure; sudden cardiac death; tool; trend

DESCRIPTION (provided by applicant): Observations from a recently completed homeless women's cohort study indicated that acute intoxication in which cocaine was detected at autopsy was the most common cause of death. This finding follows a national trend of increased overdose deaths. According to the San Francisco Medical Examiner, at least one-third of cocaine-related deaths among San Francisco women are directly linked to a cardiovascular event. While independent influences of both cocaine use and HIV infection on cardiac dysfunction have been described, combined effects and influences from polysubstance use are unclear. Such information could be used to address subclinical cardiac dysfunction prior to infarction and sudden death. Here we propose a multi- disciplinary study to understand the circumstances preceding acute drug-induced cardiovascular events among homeless women. We hypothesize that HIV, polysubstance use and concomitant medications influence chronic drug toxicity and subclinical cardiac injury. To meet our aims, the study will obtain interview data, echocardiograms and specimens for biomarker assessment among 250 homeless and unstably housed women (125 HIV+ and 125 HIV-). Results from the proposed study will provide enhanced clinical tools for risk assessment and risk stratification among cocaine users, as well as clarify endpoints for future pharmacological and behavioral interventions.

描述（由申请人提供）：最近完成的一项无家可归妇女队列研究的观察结果表明，尸检时检测到可卡因的急性中毒是最常见的死亡原因。这一发现遵循了全国服药过量死亡增加的趋势。据旧金山体检医师称，旧金山女性中至少三分之一与可卡因相关的死亡与心血管事件直接相关。虽然可卡因使用和艾滋病毒感染对心脏功能障碍的独立影响已被描述，但多种物质使用的综合影响和影响尚不清楚。此类信息可用于解决梗塞和猝死之前的亚临床心脏功能障碍。在此，我们提出一项多学科研究，以了解无家可归妇女发生急性药物诱发心血管事件之前的情况。我们假设艾滋病毒、多种物质的使用和合并用药会影响慢性药物毒性和亚临床心脏损伤。为了实现我们的目标，该研究将获取 250 名无家可归和居住不稳定的女性（125 名 HIV+ 和 125 名 HIV-）的访谈数据、超声心动图和生物标志物评估样本。拟议研究的结果将为可卡因使用者的风险评估和风险分层提供增强的临床工具，并阐明未来药理学和行为干预的终点。