BACKGROUND: We estimated the incidence of myocardial infarction (MI) and coronary revascularization (CR) among users of chronic opioid therapy (COT) and compared risks across categories of morphine-equivalent doses of COT and comparator cohorts. METHODS: We conducted a retrospective claims-based study using de-identified data from a commercially insured population. A cohort of 148,657 adult users of COT, a matched cohort of the general population, and three cohorts of users of chronic cyclooxygenase-2 (COX-2) inhibitor therapy totaling 122,810 were identified. Incidence rates and incidence rate ratios (IRRs) of MI and MI/CR were estimated. RESULTS: Adjusted IRRs for MI ranged from 1.21 (95% confidence interval [95%CI], 1.02-1.45) among those receiving low COT doses to 1.89 (95%CI, 1.54-2.33) among those receiving high doses compared with those receiving very low doses, averaging <15 mg/day. Similar patterns were shown for MI/CR. IRRs standardized to the age-sex distribution of the general cohort and adjusted for coronary heart disease risk factors showed 2.7 times the rate of MI and 2.4 times the rate of MI/CR in the COT cohort compared with the general population. Using the same analysis, COX-2 users had 1.7-1.9 times the rate of MI and MI/CR compared with the general cohort. CONCLUSIONS: Chronic analgesic use with either COT or COX-2 was associated with an increased risk of cardiovascular outcomes. These findings suggest either a selection of high-risk patients to chronic analgesic treatment, coupled with unmeasured or residual confounding, or a potential cardiovascular effect of these medications. Further research is warranted to evaluate causes for this association.
BACKGROUND: We estimated the incidence of myocardial infarction (MI) and coronary revascularization (CR) among users of chronic opioid therapy (COT) and compared risks across categories of morphine-equivalent doses of COT and comparator cohorts. METHODS: We conducted a retrospective claims-based study using de-identified data from a commercially insured population. A cohort of 148,657 adult users of COT, a matched cohort of the general population, and three cohorts of users of chronic cyclooxygenase-2 (COX-2) inhibitor therapy totaling 122,810 were identified. Incidence rates and incidence rate ratios (IRRs) of MI and MI/CR were estimated. RESULTS: Adjusted IRRs for MI ranged from 1.21 (95% confidence interval [95%CI], 1.02-1.45) among those receiving low COT doses to 1.89 (95%CI, 1.54-2.33) among those receiving high doses compared with those receiving very low doses, averaging <15 mg/day. Similar patterns were shown for MI/CR. IRRs standardized to the age-sex distribution of the general cohort and adjusted for coronary heart disease risk factors showed 2.7 times the rate of MI and 2.4 times the rate of MI/CR in the COT cohort compared with the general population. Using the same analysis, COX-2 users had 1.7-1.9 times the rate of MI and MI/CR compared with the general cohort. CONCLUSIONS: Chronic analgesic use with either COT or COX-2 was associated with an increased risk of cardiovascular outcomes. These findings suggest either a selection of high-risk patients to chronic analgesic treatment, coupled with unmeasured or residual confounding, or a potential cardiovascular effect of these medications. Further research is warranted to evaluate causes for this association.
Authors: Krish C Dewan; Karan S Dewan; Jay J Idrees; Suparna M Navale; Brad F Rosinski; Lars G Svensson; A Marc Gillinov; Douglas R Johnston; Faisal Bakaeen; Edward G Soltesz Journal: JAMA Surg Date: 2019-03-01 Impact factor: 14.766
Authors: Nicholas T Vozoris; Xuesong Wang; Peter C Austin; Douglas S Lee; Anne L Stephenson; Denis E O'Donnell; Sudeep S Gill; Paula A Rochon Journal: Eur J Clin Pharmacol Date: 2017-06-29 Impact factor: 2.953
Authors: Jeffrey F Scherrer; Joanne Salas; Patrick Lustman; Peter Tuerk; Sarah Gebauer; Sonya B Norman; F David Schneider; Kathleen M Chard; Carissa van den Berk-Clark; Beth E Cohen; Paula P Schnurr Journal: Eur J Prev Cardiol Date: 2019-05-13 Impact factor: 7.804
Authors: A Carmona-Bayonas; P Jiménez-Fonseca; E Castañón; A Ramchandani-Vaswani; R Sánchez-Bayona; A Custodio; D Calvo-Temprano; J A Virizuela Journal: Clin Transl Oncol Date: 2016-07-21 Impact factor: 3.405
Authors: Joseph W Frank; Cari Levy; Daniel D Matlock; Susan L Calcaterra; Shane R Mueller; Stephen Koester; Ingrid A Binswanger Journal: Pain Med Date: 2016-05-20 Impact factor: 3.750