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

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，在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过量死亡人数增加的趋势。根据旧金山法医的报告，至少三分之一的旧金山女性与可卡因相关的死亡与心血管疾病直接相关。虽然已经描述了可卡因使用和艾滋病毒感染对心功能障碍的独立影响，但多种物质使用的综合效应和影响尚不清楚。这些信息可用于解决梗死和猝死前的亚临床心功能障碍。在此，我们提出一项多学科研究，以了解无家可归妇女急性药物性心血管事件发生前的情况。我们假设HIV、多物质使用和伴随用药影响慢性药物毒性和亚临床心脏损伤。为了达到我们的目的，本研究将获得250名无家可归和居住不稳定的妇女（125名HIV阳性和125名HIV-）的访谈数据、超声心动图和生物标志物评估标本。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，并为未来的药理学和行为干预阐明终点。

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.