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，尸检时发现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增加的趋势。据旧金山弗朗西斯科医学检查员称，旧金山弗朗西斯科妇女中至少有三分之一与可卡因有关的死亡与心血管事件直接相关。虽然可卡因使用和HIV感染对心功能不全的独立影响已被描述，但多物质使用的联合作用和影响尚不清楚。这些信息可用于解决梗死和猝死前的亚临床心功能不全。在这里，我们提出了一个多学科的研究，以了解无家可归的妇女中急性药物引起的心血管事件之前的情况。我们假设HIV、多种药物的使用和合并用药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，这项研究将获得250名无家可归和住房不稳定的妇女（125名艾滋病毒阳性和125名艾滋病毒阴性）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，并澄清未来药理学和行为干预的终点。

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.