Abstract
Cocaine use is a well-established cardiovascular risk factor, further enhanced by concurrent alcohol use. However, cardiovascular risk is poorly managed in individuals with cocaine use disorder (CUD). This observational, cross-sectional case-control study assessed cardiac troponins T (cTnT) and I (cTnI) as biomarkers of myocardial injury in patients with CUD and/or alcohol use disorder (AUD) during abstinence. Eighty-four participants were categorized by primary substance use [cocaine (CUD, with or without AUD), alcohol (AUD), and healthy controls] and further stratified by cardiovascular diagnosis [cardiovascular (CV) and non-cardiovascular (non-CV)]. After clinical assessment, blood samples were collected for high-sensitivity cTnT and cTnI assays, and for inflammatory mediators. Patients exhibited a high prevalence of psychiatric comorbidities (67.9%). The cocaine group exhibited higher cTnT levels (p < 0.001), while the alcohol group had higher cTnI levels (p < 0.05) compared to controls. The non-CV group also had elevated troponin levels, with CUD patients displaying higher cTnT levels than AUD patients. Additionally, cTnI levels were lower in the cocaine group compared to the alcohol group (p < 0.01), and the CV group exhibited lower cTnI levels than the non-CV group (p = 0.001). CUD severity correlated with cTnT levels, while AUD severity correlated with both troponins. Inflammatory mediators correlated with troponins, particularly cTnT. Results indicate distinct troponin alterations in CUD and AUD patients, even without cardiovascular diagnosis, underscoring the importance of cardiovascular risk assessment in addiction treatment.