Advertisement
Mayo Clinic Proceedings Home

Association of Khat Chewing With Increased Risk of Stroke and Death in Patients Presenting With Acute Coronary Syndrome

      OBJECTIVE

      To evaluate the prevalence and significance of khat chewing in patients with acute coronary syndrome (ACS).

      PATIENTS AND METHODS

      From January 29, 2007, through July 29, 2007, 8176 consecutive patients presenting with ACS were enrolled in a prospective, multicenter study from 6 adjacent Middle Eastern countries.

      RESULTS

      Of the 8176 study patients, 7242 (88.6%) were non-khat chewers, and 934 (11.4%) were khat chewers, mainly of Yemeni origin. Khat chewers were older (57 vs 56 years; P=.01) and more likely to be men (85.7% vs 74.5%) compared with non-khat chewers. Non-khat chewers were more likely to have diabetes mellitus, hypertension, dyslipidemia, obesity, and prior history of coronary artery disease and revascularization. Cigarette smoking was more prevalent in khat chewers, and they were more likely to present greater than 12 hours after onset of symptoms compared with non-khat chewers. At admission, khat chewers had higher heart rate, Killip class, and Global Registry of Acute Coronary Events risk scores. Khat chewers had a significantly higher risk of cardiogenic shock, stroke, and mortality. After adjustment of baseline variables, khat chewing was an independent risk factor for in-hospital mortality (odds ratio, 1.9; 95% confidence interval, 1.3-2.7; P<.001) and stroke (odds ratio, 2.7; 95% confidence interval, 1.3-5.9; P=.01).

      CONCLUSION

      In this large cohort of patients with ACS, khat chewing was prevalent and was associated with increased risk of stroke and death. In the context of increasing global migration, a greater awareness of potential widespread practices is essential.
      ACS (acute coronary syndrome), MI (myocardial infarction), NSTEMI (non-ST-segment elevation myocardial infarction), STEMI (ST-segment elevation myocardial infarction)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Kalix P
        The pharmacology of khat.
        Gen Pharmacol. 1984; 15: 179-187
        • Kennedy JG
        The Flower of Paradise: The Institutionalized Use of the Drug Qat in North Yemen. Springer, Dordrecht, The Netherlands1987: 60-107
        • Getahun A
        • Krikorian AD
        Chat: coffee's rival from Harar, Ethiopia: I. botany, cultivation and use.
        Econ Bot. 1973; 27: 353-377
        • Brenneisen R
        • Fisch HU
        • Koelbing U
        • Geisshusler S
        • Kalix P
        Amphetamine-like effects in humans of the khat alkaloid cathinone.
        Br J Clin Pharmacol. 1990; 30: 825-828
        • Kalix P
        Cathinone a natural amphetamine.
        Pharmacol Toxicol. 1992; 70: 77-86
        • Cox G
        • Rampes H
        Adverse effects of khat: a review.
        Adv Psychiatr Treat. 2003; 9: 456-463
        • Balint EE
        • Falkay G
        • Balint GA
        Khat—a controversial plant.
        Wien Klin Wochenschr. 2009; 121: 604-614
        • Kalix P
        Catha edulis, a plant that has amphetamine effects.
        Pharm World Sci. 1996; 18: 69-73
        • Intitute for the Study of Drug Dependence
        Druglink Factsheet No. 9. Khat (Qat, Chat). Institute for the Study of Drug Dependence, London, England1994
        • Browne DL
        Qat use in New York City.
        NIDA Res Monogr. 1990; 105: 464-465
      1. Khat (Catha edulis). Intelligence Bulletin 2003-L0424-002. National Drug Intelligence Center Web site. Published May 2003.
        (Accessed August 5, 2010.)
        • Anderson D
        • Beckerleg S
        • Hailu D
        • Klein A
        The Khat Controversy: Stimulating the Debate on Drugs. Berg, Oxford, UK2007: 62-65
        • El-Menyar A
        • Zubaid M
        • Sulaiman K
        • Al Thani H
        • Singh R
        • Al Suwaidi J
        In-hospital major outcomes in patients with chronic renal insufficiency presenting with acute coronary syndrome: data from a registry of 8,176 patients.
        Mayo Clin Proc. 2010; 85: 332-340
        • El-Menyar A
        • Zuabid M
        • Rashed W
        • et al.
        Comparison of men and women with acute coronary syndrome in six Middle Eastern countries.
        Am J Cardiol. 2009; 104: 1018-1022
        • Al Suwaidi J
        • Reddan DN
        • Williams K
        • et al.
        Prognostic implications of abnormalities in renal function in patients with cute coronary syndrome.
        Circulation. 2002; 106: 974-980
        • Cornnor J
        • Makonnen E
        • Rostom A
        Comparison of analgesic effects of Khat (Catha edulis Forsk) extract, D-amphetamine and ibuprofen in mice.
        J Pharm Pharmacol. 2000; 52: 107-110
        • Al-Motarreb A
        • Briancon S
        • Al-Jaber N
        • et al.
        Khat-chewing is a risk factor for acute myocardial infarction: a case-control study.
        Br J Clin Pharmacol. 2005; 59: 574-581
        • Al-Motarreb A
        • Al-Kebsi M
        • Al-Adhi B
        • Broadley KJ
        Khat chewing and acute myocardial infarction.
        Heart. 2002; 87: 279-280
        • Alkadi HO
        • Noman MA
        • Al-Thobhani AK
        • Al-Mekhlafi FS
        • Raja'a YA
        Clinical and experimental evaluation of the effect of Khat induced myocardial infarction.
        Saudi Med J. 2002; 23: 1195-1198
        • Alem A
        • Kebede D
        • Kullgren G
        The prevalence and socio-demographic correlates of khat chewing in Butajira, Ethiopia.
        Acta Psychiatr Scand Suppl. 1999; 397: 84-91
        • Griffiths R
        Qat use in London: a study of qat use among a sample of Somalis living in London. Home Office, Central Drugs Prevention Unit, London, England1998 (Drugs Prevention Initiative Paper No. 26.)
        • Bhui K
        • Abdi A
        • Abdi M
        • et al.
        Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees–preliminary communication.
        Soc Psychiatry Psychiatr Epidemiol. 2003; 38: 35-43
        • Griffiths P
        • Gossop M
        • Wickenden S
        • Dunworth J
        • Harris K
        • Lloyd C
        A transcultural pattern of drug use: qat (khat) in the UK.
        Br J Psychiatry. 1997; 170: 281-284
        • Patel SL
        Attitudes to khat use within the Somali community in England.
        Drugs Educ Prev Policy. 2008; 15: 37-53
        • Tesfaye F
        • Byass P
        • Wall S
        • Berhane Y
        • Bonita R
        Association of smoking and khat (Catha edulis Forsk) use with high blood pressure among adults in Addis Ababa, Ethiopia 2006.
        Prev Chronic Dis. 2008; 5: A89
        • Hassan NA
        • Gunaid AA
        • Abdo-Rabbo AA
        • et al.
        The effect of Qat chewing on blood pressure and heart rate in healthy volunteers.
        Trop Doct. 2000; 30: 107-108
        • Toennes SW
        • Harder S
        • Schramm M
        • Niess C
        • Kauert GF
        Pharmacokinetics of cathinone, cathine and norephedrine after the chewing of khat leaves.
        Br J Clin Pharmacol. 2003; 56: 125-130
        • Hassan NA
        • Gunaid AA
        • Khally FM
        • Murray-Lyon IM
        Khat chewing and arterial blood pressure: a randomized controlled clinical trial of alpha-1 and selective beta-1 adrenoreceptor blockade.
        Saudi Med J. 2005; 26: 537-541
        • Gugelmann R
        • von Allmen M
        • Breinneisen R
        • Portzig H
        Quantitative differences in the pharmacological effect of (+) and (−)-cathinone.
        Experientia. 1985; 41: 1568-1571
        • Saha S
        • Dollery C
        Severe ischemic cardiomyopathy associated with khat chewing.
        J R Soc Med. 2006; 99: 316-318
        • Bawazeer A
        • Hattab A
        • Morales E
        First cigarette smoking experience among secondary-school students in Aden, Republic of Yemen.
        East Mediterr Health J. 1999; 5: 440-449
        • Haft JI
        • Kranz PD
        • Albert FJ
        • Fani K
        Intravascular platelet aggregation in the heart induced by norepinephrine: microscopic studies.
        Circulation. 1972; 46: 698-708
        • Al-Motarreb A
        • Broadley KJ
        Coronary and aortic vasoconstriction by cathinone, the active constituent of khat.
        Auton Autacoid Pharmacol. 2003; 23: 319-326
        • Baker KE
        • Herbert AA
        • Broadley KJ
        Vasoconstriction of porcine left anterior descending coronary artery by ecstasy and cathinone is not an indirect sympathomimetic effect.
        Vascul Pharmacol. 2007; 47: 10-17
        • Ragland AS
        • Ismail Y
        • Arsura EL
        Myocardial infarction after amphetamine use.
        Am Heart J. 1993; 125: 247-249
        • Packe GE
        • Garton MJ
        • Jennings K
        Acute myocardial infarction caused by intravenous amphetamine abuse.
        Br Heart J. 1990; 64: 23-24
        • Wijetunga M
        • Bhan R
        • Lindsay J
        • Karch S
        Acute coronary syndrome and crystal methamphetamine use: a case series.
        Hawaii Med J. 2004; 63 (25.): 8-13
        • Turnipseed SD
        • Richards JR
        • Kirk JD
        • Diercks DB
        • Amsterdam EA
        Frequency of acute coronary syndrome in patients presenting to the emergency department with chest pain after methamphetamine use.
        J Emerg Med. 2003; 24: 369-373
        • Bashour TT
        Acute myocardial infarction resulting from amphetamine abuse: spasm-thrombus interplay?.
        Am Heart J. 1994; 128: 1237-1239
        • Graziani M
        • Milella MS
        • Nencini P
        Khat chewing from the pharmacological point of view: an update.
        Subst Use Misuse. 2008; 43: 762-783
        • Yeo KK
        • Wijetunga M
        • Ito H
        • et al.
        The association of methamphetamine use and cardiomyopathy in young patients.
        Am J Med. 2007; 120: 165-171
      2. Robinson M, Turnipseed S, Glatter K. Methamphetamine-associated cardiomyopathy: a previously unrecognized cause of heart failure [abstract]. Presented at: American Heart Association Annual Scientific Sessions. New Orleans, LA: 2004.

        • Maeno Y
        • Iwasa M
        • Inoue H
        • et al.
        Direct effects of methamphetamineon hypertrophy and microtubules in cultured adult rat ventricular myocytes.
        Forensic Sci Int. 2000; 113: 239-243
        • He SY
        • Matoba R
        • Fujitani N
        • Koyama H
        • Matoba R
        • Nagao M
        Cardiac muscle lesions associated with chronic administration of methamphetamine in rats.
        Am J Forensic Med Pathol. 1996; 17: 155-162
        • Lange RA
        • Cigarroa RG
        • Flores ED
        • et al.
        Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade.
        Ann Intern Med. 1990; 112: 897-903
        • Vanwalleghem IE
        • Vanwalleghem PW
        • De Bleecker JL
        Khat chewing can cause stroke.
        Cerebrovasc Dis. 2006; 22: 198-200
        • Mujlli HM
        • Bo X
        • Zhang L
        The effect of Khat (Catha edulis) on acute cerebral infarction [abstract].
        Neurosciences. 2005; 10: 219-222
        • Bruno A
        Cerebrovascular complications of alcohol and sympathomimetic drug abuse.
        Curr Neurol Neurosci Rep. 2003; 3: 40-45
        • Miranda J
        • O'Neill D
        Stroke associated with amphetamine use.
        Ir Med J. 2002; 95: 281-282

      Linked Article

      • Khat Chewing: A Smokeless Gun?
        Mayo Clinic ProceedingsVol. 85Issue 11
        • Preview
          Chewing the leaves of the plant Catha edulis (referred to as khat, African salad, bushman's tea) likely dates to times of antiquity and may predate the use of coffee.1 An early written description of khat appeared in Paris in 1697 when Barthelemy d'Herbelot de Molainville traveled to Yemen (translated): “[It] is made with a seed which is unknown to us, which has been forbidden by the doctors of the law in the province of Yemen…, where it originated. …because it is too strong, and affects the brain.”2 It was not until 1975 that United Nations laboratories first discovered the active ingredient of khat to be cathinone, an amphetamine-like substance that has sympathomimetic, euphoric, and mood-altering effects among other health consequences.
        • Full-Text
        • PDF