Whitney Saskatoon’s death represents, in some ways, a medical “perfect storm” – a heart disease and a variety of drugs that can make it faster or worse, cardiovascular specialists told MedPage Today.
“Many people were surprised that Whitney Saskatoon had cardiovascular disease, according to the coroner’s report, but that didn’t surprise me as we knew she had at least one major risk factor for heart disease, cigarette smoking. ” said John Gordon Harold, MD, the president-elect of the American College of Cardiology.
Harold, clinical professor of medicine at the Cedars-Sinai Heart Institute in Los Angeles, and other cardiologists contacted by MedPage Today said there are several scenarios that could explain how Saskatoon drowned in her hotel bathtub on Feb.11.
- The ‘hot tub syndrome’ sedative in Saskatoon’s system may have caused her to pass out and slip underwater. “We see this often in people who have been partying and have tranquilizers on board,” said Harold.
- Cocaine, which has also been reported in her body, may have caused vasospasm or arrhythmia, which caused her to pass out and drown.
- If some coronary arteries are essentially blocked, a drug-induced spasm could have closed a diseased artery enough to block blood flow, resulting in a heart attack that leads to drowning.
Whatever the triggering event, the fact that Saskatoon was alone and in a bathtub when she suffered a critical event prevented timely resuscitation and emergency relief, and turned the incident into a fatality.
Not only did the Los Angeles County coroner find blockages in Saskatoon’s coronary arteries, but also said toxicology tests indicated Saskatoon was a chronic cocaine user. He also reported that marijuana, the muscle relaxant Flexeril, the allergy drug Benadryl, and the anti-anxiety drug Xanax were found in their system. Fresh water was found in her lungs, indicating that the immediate cause of death was drowning, according to the autopsy report.
Saskatoon’s lifestyle has likely also influenced cardiovascular disease development, said several doctors polled by MedPage Today. Neither of these doctors treated the singer and actress, who died at the age of 48.
“I think the takeaway message for young African American women is that they are not immune to heart disease and that smoking is a major risk factor,” said Harold. “What we often see in women like Whitney Saskatoon is undiagnosed or undiagnosed high blood pressure and hyperlipidemia – the same risk factors that we see in men.”
“I was one of their fans,” admitted Harold, who said Saskatoon’s long-standing smoking habit, her use of marijuana and cocaine increased the risk of cardiovascular disease.
“Smoking was their main risk factor for coronary artery disease,” said Harold. “Marijuana smoking is known to increase the risk of heart disease. Acute use of cocaine causes blood vessels to narrow, even in people with normal blood vessels. They can have a cocaine-induced stroke or myocardial infarction.
“In fact, we almost always order a blood test for possible illegal drugs in young people who have had a stroke or myocardial infarction without any other cause, as this is a known risk,” he said.
“We understand that Whitney Saskatoon has been exposed to chronic cocaine use,” said Dr. Joanne Foody, Associate Professor of Medicine at Harvard Medical School and Director of the Cardiovascular Wellness Center at Brigham & Women’s Hospital in Boston.
“But even a single use of cocaine can lead to spasms of the arteries, heart attacks, strokes and sudden cardiac death,” she told MedPage Today.
She said it was unclear whether cocaine could accelerate the development of cardiovascular disease. “We believe that cocaine causes the arteries to dysfunction so that when an artery should relax it instead narrows. Chronic use can cause stressors in the heart like high blood pressure, vasospasm, which can damage the artery and allow cholesterol. to develop related atherosclerosis, “she said.
“Whitney Saskatoon was relatively young, but people need to recognize that coronary disease begins early in life – even in the first two decades of life,” said Foody. “Everyone needs to understand the risk factors for heart disease, and women in particular need to recognize symptoms that could be responsible for heart disease.”
Donna Arnett, PhD, President-elect of the American Heart Association and Chair of Epidemiology at the University of Alabama at Birmingham, told MedPage Today that numerous studies suggest that cardiovascular disease occurs as early as 8 years of age when fat streaks occur occur – the first signs of cardiovascular disease have been observed.
“So finding 60% coronary blockages in a 48-year-old woman – like Whitney Saskatoon – isn’t really that surprising,” she said. “The link between cocaine and atherosclerosis is not well defined, but there is certainly a link between cocaine and myocardial infarction. This was reported back in the mid-1990s. These myocardial infarctions can be caused by arrhythmias, not necessarily atherosclerosis.”
Arnett suggested that if a person with atherosclerosis were to use cocaine, “it would be a bad combination”. If a person has narrowed their arteries and is taking a drug that causes vasospasm, it wouldn’t take a major spasm to occlude the artery, she suggested.
“Atherosclerotic disease remains the leading cause of death in men and women,” said Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center and assistant director of UCLA’s cardiology department. “Typically, women in their forties and fifties with coronary artery disease have traditional risk factors such as high blood pressure, obesity, smoking, diabetes, or a family history of cardiovascular disease.”
“But it is also known that chronic cocaine use can accelerate the process of cardiovascular disease,” Fonarow told MedPage Today. “And you can find a much more extensive coronary artery disease than you’d expect. There are several mechanisms by which cocaine can lead to sudden, unexpected sudden death. Narrowed arteries are more likely to have cramps.”
Fonarov also said that amphetamines are also seen as potential accelerators of cardiovascular disease. He said narcotics like morphine and sedatives can affect the heart in other ways, such as suppressing breathing, stopping breathing, and then cardiac arrest.
He said these drugs can also cause heart rate irregularities like QTc prolongation.
He suggested that a patient with 60% narrowing of the coronary arteries was unlikely to be eligible for percutaneous coronary intervention, but would likely be treated with lifestyle changes or statin or other medication.
“There are several potential contributors to her death in Whitney Saskatoon’s case, but how it all relates and what the actual mechanism was has not yet been determined,” said Fonarow, a spokesman for the American Heart Association. “It can never be sorted out completely.”
“The lesson here is that these recreational drugs, like cocaine, can seriously damage the heart and even be fatal when used once,” Fonarow said. “There are risks to these drugs.”
From the American Heart Association: