She was young, only in her 40s. Tall, slender and oh, so glamorous with a voice that gave us chills.
The coroner said Whitney Houston died from drowning in her hotel bathtub in February, which may not have surprised those who have followed her sad history of substance abuse.
But the coroner also noted that significant heart disease was a contributing factor in her death.
Houston had atherosclerosis, a buildup of plaque in her arteries — a condition often associated with age and obesity.
Yet heart disease, doctors say, is a frequent consequence of abusing drugs, alcohol and tobacco. The coroner's report noted the presence of cocaine, marijuana and prescription drugs in Houston, who also was reported to be a smoker and a drinker.
"Certain drugs of abuse pose a significant risk for heart disease — tobacco, cocaine, amphetamines, alcohol. It's a major risk factor for heart disease, but much less recognized," said Dr. Richard Denisco of the National Institute on Drug Abuse, part of the National Institutes of Health.
Denisco explained that chronic cocaine use causes inflammation in the arteries. The body tries to protect itself by pulling lipids and platelets from the blood stream to repair and smooth out the inflamed artery walls.
"We know that cocaine is an irritant to arteries and increases the production of mast cells which trigger the inflammatory process. Why cocaine does it we really don't know. But we find increased atherosclerosis in young people with a significant coke history all the time," said Denisco.
Drugs that rev up the heart such as cocaine and amphetamines can also cause spasms in the arteries that mimic a heart attack.
"The vessels are literally closing up," said Dr. Leslie Miller, cardiovascular sciences chairman at the USF Health Morsani College of Medicine.
The usual scenario: A healthy-looking, young person goes to a hospital emergency department complaining of chest pain.
"We see it at least a couple of times a month here," said Dr. Brad Peckler, an emergency medicine specialist at Tampa General Hospital.
It's crucial to be honest with the doctor, "because the treatment is different if the symptoms are caused by drug abuse. We wouldn't give someone on cocaine the same medications we would give someone having a heart attack. It could be life-threatening," said Peckler.
These spasms are especially dangerous in people who have plaque buildup in their arteries. Squeezing a vessel suddenly can cause plaque to rupture, break off, and travel in the bloodstream. If a bit of plaque reaches a narrow section of vessel, it can block blood flow, causing a heart attack.
"It can happen with a single use," said Miller, "but the more you use and the longer the vessels are constricted, the more likely you are to cause a heart attack."
Even worse is drug abuse combined with alcohol.
"Alcohol and cocaine together form a compound that can cause plaques to form," said Peckler. "So if you start in your teens doing a lot of drugs and drinking a lot of alcohol, by the time you're 30, you have the heart of a 50-year- old."
Many addicts also smoke, and tobacco itself is a major cause of atherosclerosis and other types of heart disease as well as cancer and lung disease. In fact, smoking is the No. 1 cause of preventable death in the United States.
Cocaine, amphetamines and alcohol damage blood vessels and the heart muscle itself.
"You're changing the structure of your heart tissue with long-term drug abuse," said Glenn Whelan, a doctor of pharmacy and assistant professor in the USF College of Pharmacy.
Chronic heavy drinking makes the heart work increasingly harder to pump blood, and that enlarges the muscle. "The bigger it gets, the less blood it pumps and the more it tries to compensate by getting even larger," said Denisco. The end result is usually congestive heart failure.
Alcohol abuse can also affect the heart's electrical system, resulting in arrhythmia, an abnormal heartbeat. Alcohol and drug abuse are also associated with abnormal clot formation, which can lead to blood vessel blockages, heart attack and stroke.
Prescription painkillers, among the most abused substances today, don't cause the same damage to the heart. Instead these sedating drugs cause problems with breathing, which is why an overdose is potentially fatal.
Contact Irene Maher at firstname.lastname@example.org.