New Research Into Cocaine's Damaging Effects on the Heart
Cocaine poses threats to the heart, and alcohol makes the danger even worse.
Posted July 19, 2025 | Reviewed by Margaret Foley
Most people abusing both alcohol and cocaine don’t realize that these two drugs make risky use so much more deadly. They need to know. New research reveals problematic cardiac changes in patients with both cocaine and alcohol use disorders. This raises concerns about the effects of cocaine and alcohol use on the heart, even after treatment and abstinence.
Researchers studied 84 participants with substance use (cocaine addicts with and without alcohol use, other groups, and healthy controls). Subjects were further stratified by a cardiovascular diagnosis. Highly sensitive cardiac troponin T (cTnT) blood levels were measured. Cardiac troponin levels are markers for heart attack and other heart abnormalities. CTnT is a substance released into the bloodstream with damage to heart muscle. It includes troponin I (cTnI), a protein in heart muscle cells that regulates muscle contraction. The research showed distinct cardiac troponin blood alterations in cocaine addicts.
When heart muscle is damaged during heart attack (myocardial infarction), cTnI releases into the bloodstream. The major research finding was that cocaine use disorder (CUD) patients showed significantly elevated cTnT levels relative to controls. In addition, patients with alcohol use disorder (AUD) exhibited elevated cTnI levels relative to controls.
While research indicates combined use of cocaine and alcohol poses greater threat than either substance alone, there may be different mechanisms of injury. Among patients with no known cardiovascular diagnoses, CUD patients had higher cTnT levels and lower levels of cTnI than AUD patients. This suggests possible subclinical myocardial injury caused by cocaine distinct from alcohol’s effects. Sadly, even with abstinence and without overt cardiovascular disease, substance use disorders (especially cocaine) are associated with detectable and important heart and injury signals.
This study reminds us that among drug combinations, cocaine (and methamphetamine) is a well-established cardiovascular risk factor. The combined use of methamphetamine/cocaine plus alcohol may cause cardiovascular disease (CVD) problems so often that when addiction treatment begins in early abstinence, physicians should consider a cardiovascular risk assessment.
New Data on Cocaine and the Heart From Yale and Penn
Two new studies contributed complementary insights into the cardiovascular consequences of cocaine, methamphetamine, and other stimulants. Harris et al. at the University of Pennsylvania performed a national trend analysis in the U.S. for 2014–2023 on stimulant ‑involved CVD mortality, including cocaine and methamphetamine.
This study revealed a steep, sustained rise in stimulant-involved cardiovascular disease mortality in the United States between 2014 and 2023. This increase was especially pronounced among older adults, non-Hispanic American Indian/Alaska Native populations, and individuals with methamphetamine involvement, although cocaine also contributed significantly to overall mortality. The study highlighted that while overall CVD mortality remained relatively stable, stimulant-associated CVD deaths markedly increased, resulting in a staggering 1 million years of life lost. Middle-aged men and non-Hispanic Whites bore the highest burden.
The Yale study by Burke, Ely & Gill, reported in 2025, performed a forensic pathology comparison between cocaine intoxication deaths (n=78) and fentanyl intoxication deaths (n=306). The study showed that nearly 90 percent of those who died from cocaine had pre-existing atherosclerotic or hypertensive heart disease. In contrast, this was true in only 40 percent of fentanyl deaths. This finding underscores that cocaine-related deaths often involve interaction between the stimulant and pre-existing cardiovascular pathology, rather than acute toxicity alone.
The Penn study underlines a need for broad, population-level interventions to address the rising burden of stimulant-related cardiac mortality. Meanwhile, the Yale study reinforces the clinical importance of screening for cardiovascular disease in living patients with known/suspected cocaine use, since underlying cardiac pathology significantly increases risks of sudden death. In combination, these studies indicate the importance of implementing public health policies that help high-risk populations and ensure clinical evaluations and treatment of subclinical or established cardiovascular disease in adults abusing psychostimulants.
Alcohol and the Heart
Chronic heavy alcohol use has a direct negative effect on the heart, referred to as myocardial toxicity. This causes cardiomyopathy, arrhythmias, and hypertension. In the Porras‑Perales et al. study described at the beginning of this post, researchers found that alcohol use was associated with elevated cTnI, suggesting subclinical injury.
Chronic alcohol use contributes to dilated cardiomyopathy, atrial fibrillation, left ventricular dysfunction, and increased heart failure risk. Troponin (cTnI) elevations in AUD patients may reflect ongoing myocardial stress /damage, even absent overt cardiovascular disease.
Cocaine + Alcohol → Cocaethylene
A 2024 systematic review compiled evidence on the effects of the simultaneous use of alcohol and cocaine, leading to the development of a new substance: cocaethylene. Evidence shows an 18 to 25 times greater risk of sudden death in the presence of cocaethylene versus cocaine alone.
Cocaethylene prolongs stimulant effects. Researchers found people with coronary artery disease (CAD) using both substances had a 21 times greater risk of sudden death compared to those using cocaine alone. Combined use also elevates heart rate and blood pressure, increasing bodily demands.
Some emergency department (ED) studies found higher ICU admissions and more confusion or arrhythmia markers in co‑users of cocaine and alcohol; others found no difference in chest pain or general cardiotoxic symptoms in users of both drugs compared with cocaine users alone.
Cardiology Expert Interprets New Findings
According to Harvard’s Daniel Blumenthal, M.D., cocaine use alone carries substantial cardiovascular risk, which can lead to myocardial infarction (MI), heart failure, and sudden death, as well as subclinical myocardial injury measurable by elevated cTnT.
He notes that alcohol alone can cause direct myocardial damage and arrhythmic risks, reflected in elevated cTnI, even without symptomatic disease. However, the combined use of cocaine and alcohol often heightens cardiovascular danger, markedly increasing risks for mortality and sudden death.
Blumenthal added, “Elevated cardiac troponins—whether acute or chronic and whether in the setting of coronary artery disease or not—do predict higher rates of adverse cardiovascular events.” Fentanyl use and co-use of cocaine and alcohol are also associated with myocardial injury, suggesting many drugs of abuse may cause cardiac injury over time.
Blumental continued, “In managing patients with cocaine and/or alcohol use disorders, clinicians should consider screening for subclinical myocardial injury (e.g., with high-sensitivity troponin assays). They should also follow patients after they stop using [substances], as it appears even during abstinence, prior use may have persistent cardiac effects.” Blumenthal says patients and families should be aware of the extraordinary cardiovascular hazards of using alcohol with cocaine, especially caused by cocaethylene.
Since addiction medicine or addiction psychiatry specialists are not generally trained in cardiology, education is needed to integrate cardiologists' understanding of the importance of cardiovascular risk reduction within addiction treatment protocols.
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Mark S. Gold, M.D., is a pioneering researcher, professor, and chairman of psychiatry at Yale, the University of Florida, and Washington University in St Louis.
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