The bare-bones release of Whitney Houston’s cause-of-death Thursday by the Los Angeles Country Department of the Coroner’s office wasn’t shocking, but it did raise some questions. The singing great died at age 48 of drowning (in a hotel room bathtub), atherosclerosis (hardening of the arteries), and cocaine use, the report indicated. The primary cause was accidental drowning and it’s uncertain whether she had a heart attack. But the L.A. Coroner’s office indicated that cardiovascular disease was a contributing factor and there were signs of “chronic usage” of cocaine.According to a spokeswoman for the San Diego County Medical Examiner’s Office -- who stressed she was not commenting on Whitney Houston’s death in particular -- “the chronic use of cocaine can have various effects on the heart” and cardiovascular system. “Cocaine, like other stimulants, can exacerbate pre-existing heart disease, such as coronary artery disease or hypertension. In the presence of these pre-existing diseases, cocaine can cause heart failure, heart attack or sudden death,” the spokeswoman Sarah Gordon said. Chronic use of cocaine has been shown to accelerate the development of atherosclerosis, the formation of plaques inside blood vessels, even in young people. Those plaques can eventually lead to severe narrowing of the vessels, causing heart attack, stroke, or a transient ischemic attack, a so-called “ministroke.”As many older people who have experienced a TIA can attest, a ministroke can leave you disoriented, cause fainting, and falls. If one happens to be in a bathtub at the time, that could be deadly. A University of California San Francisco study found that “ischemic stroke/TIA is a common neurovascular presentation in patients with a remote history of cocaine use, often as a result of atherosclerotic disease.” Additionally, bits of plaque can break off and block a vital vessel, also causing a heart attack or stroke. There’s more danger of that happening after something stimulating, like exercise. A study of sports-related deaths among schoolchildren in Australia concluded that “the fatal episodes often resulted from a complex interplay of a variety of factors, including physical exertion, possible trauma, and underlying organic disease” including, in one case, atherosclerosis. Smoking a cigarette and getting the rush of nicotine, or, as Whitney Houston did, taking cocaine, can have similar cardiovascular effects as exercise. So can hot water. A 1991 study of 151 drowning and hyperthermia deaths in spas, Jacuzzis and hot tubs found that in 14 percent of them, cocaine – with or without alcohol ingestion – was implicated as a contributing factor. The anti-anxiety prescription medication Xanax and the antihistamine Benadryl were also found in her system but are not believed to have contributed to her death. However, nothing can be confirmed until the final report is released. On TODAY Friday, chief medical editor Dr. Nancy Snyderman noted that the coroner didn't connect the other medications to her death, but that the drug interactions shouldn't be ignored. "It doesn’t have to be one drug in a whopping amount; it can be a lot of little things, and when you compound it, it can be enough to cause death," Snyderman said. Whatever the combination of factors that led to her death, there is an important message in Houston’s sad story: The effects of chronic cocaine use can cause physical damage capable of haunting users even long after they’ve stopped.