Mahdi Nalini1,2, Ramin Shakeri1, Hossein Poustchi3,4, Akram Pourshams1,4, Arash Etemadi1,5, Farhad Islami1,6, Masoud Khoshnia1,7, Abdolsamad Gharavi1,7, Gholamreza Roshandel1,7, Hooman Khademi1, Mahdi Zahedi8, Behnoush Abedi-Ardekani9, Rajesh Vedanthan10, Paolo Boffetta11, Sanford M Dawsey5, Paul D Pharaoh12, Masoud Sotoudeh1, Christian C Abnet5, Nicholas E Day12, Paul Brennan9, Farin Kamangar13, Reza Malekzadeh1,3,4. 1. Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran. 2. Cardiovascular Research Center, Kermanshah University of Medical Sciences, Imam Ali Hospital, Shahid Beheshti Boulevard, Kermanshah, Iran. 3. Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran. 4. Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran. 5. Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. 6. Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA. 7. Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran. 8. Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran. 9. Section of Genetics, International Agency for Research on Cancer, World Health Organization, Lyon, France. 10. Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA. 11. Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 12. Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. 13. Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University Portage Avenue Campus, Room 103, Baltimore, MD 21251, USA.
Abstract
AIMS: Tens of millions of people worldwide use opiates but little is known about their potential role in causing cardiovascular diseases. We aimed to study the association of long-term opiate use with cardiovascular mortality and whether this association is independent of the known risk factors. METHODS AND RESULTS: In the population-based Golestan Cohort Study-50 045 Iranian participants, 40-75 years, 58% women-we used Cox regression to estimate hazard ratios and 95% confidence intervals (HRs, 95% CIs) for the association of opiate use (at least once a week for a period of 6 months) with cardiovascular mortality, adjusting for potential confounders-i.e. age, sex, education, wealth, residential place, marital status, ethnicity, and tobacco and alcohol use. To show independent association, the models were further adjusted for hypertension, diabetes, waist and hip circumferences, physical activity, fruit/vegetable intake, aspirin and statin use, and history of cardiovascular diseases and cancers. In total, 8487 participants (72.2% men) were opiate users for a median (IQR) of 10 (4-20) years. During 548 940 person-years-median of 11.3 years, >99% success follow-up-3079 cardiovascular deaths occurred, with substantially higher rates in opiate users than non-users (1005 vs. 478 deaths/100 000 person-years). Opiate use was associated with increased cardiovascular mortality, with adjusted HR (95% CI) of 1.63 (1.49-1.79). Overall 10.9% of cardiovascular deaths were attributable to opiate use. The association was independent of the traditional cardiovascular risk factors. CONCLUSION: Long-term opiate use was associated with an increased cardiovascular mortality independent of the traditional risk factors. Further research, particularly on mechanisms of action, is recommended. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Tens of millions of people worldwide use opiates but little is known about their potential role in causing cardiovascular diseases. We aimed to study the association of long-term opiate use with cardiovascular mortality and whether this association is independent of the known risk factors. METHODS AND RESULTS: In the population-based Golestan Cohort Study-50 045 Iranian participants, 40-75 years, 58% women-we used Cox regression to estimate hazard ratios and 95% confidence intervals (HRs, 95% CIs) for the association of opiate use (at least once a week for a period of 6 months) with cardiovascular mortality, adjusting for potential confounders-i.e. age, sex, education, wealth, residential place, marital status, ethnicity, and tobacco and alcohol use. To show independent association, the models were further adjusted for hypertension, diabetes, waist and hip circumferences, physical activity, fruit/vegetable intake, aspirin and statin use, and history of cardiovascular diseases and cancers. In total, 8487 participants (72.2% men) were opiate users for a median (IQR) of 10 (4-20) years. During 548 940 person-years-median of 11.3 years, >99% success follow-up-3079 cardiovascular deaths occurred, with substantially higher rates in opiate users than non-users (1005 vs. 478 deaths/100 000 person-years). Opiate use was associated with increased cardiovascular mortality, with adjusted HR (95% CI) of 1.63 (1.49-1.79). Overall 10.9% of cardiovascular deaths were attributable to opiate use. The association was independent of the traditional cardiovascular risk factors. CONCLUSION: Long-term opiate use was associated with an increased cardiovascular mortality independent of the traditional risk factors. Further research, particularly on mechanisms of action, is recommended. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Bryan Williams; Giuseppe Mancia; Wilko Spiering; Enrico Agabiti Rosei; Michel Azizi; Michel Burnier; Denis L Clement; Antonio Coca; Giovanni de Simone; Anna Dominiczak; Thomas Kahan; Felix Mahfoud; Josep Redon; Luis Ruilope; Alberto Zanchetti; Mary Kerins; Sverre E Kjeldsen; Reinhold Kreutz; Stephane Laurent; Gregory Y H Lip; Richard McManus; Krzysztof Narkiewicz; Frank Ruschitzka; Roland E Schmieder; Evgeny Shlyakhto; Costas Tsioufis; Victor Aboyans; Ileana Desormais Journal: Eur Heart J Date: 2018-09-01 Impact factor: 29.983
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