Combined effect of posttraumatic stress disorder and prescription opioid use on risk of cardiovascular disease

Abstract

Aim Prescription opioid analgesic use (OAU) is associated with increased risk of cardiovascular disease (CVD). OAU is more common in patients with than without posttraumatic stress disorder (PTSD), and PTSD is associated with higher CVD risk. We determined whether PTSD and OAU have an additive or multiplicative association with incident CVD. Methods and results Veterans Health Affairs patient medical record data from 2008 to 2015 was used to identify 2861 patients 30–70 years of age, free of cancer, CVD and OAU for 12 months before index date. We defined a four-level exposure variable: 1) no PTSD/no OAU, 2) OAU alone, 3) PTSD alone and 4) PTSD+OAU. Cox proportional hazard models estimated the association between the exposure variable and incident CVD. The mean age was 49.0 (±11.0), 85.7% were male and 58.3% were White, 34.4% had no PTSD/no OAU, 32.9% had PTSD alone, 10.6% had OAU alone, and 22.1% had PTSD+OAU. Compared with patients with no PTSD/no OAU, those with PTSD alone were not at increased risk of incident CVD (hazard ratio = 0.82; 95% confidence interval (CI): 0.63–1.17); however, OAU alone and PTSD+OAU were both significantly associated with incident CVD (hazard ratio = 1.99; 95% CI:1.36–2.92 and hazard ratio = 2.20; 95% CI: 1.61–3.02). There was no significant additive or multiplicative PTSD and OAU association with incident CVD. Conclusion OAU is associated with nearly a two-fold increased risk of CVD in patients with and without PTSD. Despite no additive or multiplicative interaction effects, the high prevalence of OAU in PTSD may represent a novel contributor to the elevated CVD burden among patients with PTSD.

Effect of persistent opium consumption after surgery on the long-term outcomes of surgical revascularisation

“…Although the exact underlying mechanisms for the increased risk of MACCEs in opium-consuming patients remain to be elucidated, multiple mechanisms have been suggested for the increased risk of CVD and cardiovascular events in opium consumers. 10,15 It is well known that inflammation and oxidative stress play a pivotal role in coronary atherosclerosis and also the susceptibility of existing atheromatous plaques to acute events. 16 Multiple studies have reported that opium could induce oxidative stress and inflammation by generating proinflammatory mediators.…”

Opium consumption in coronary artery bypass graft patients: Escaping from an addiction towards better outcomes

“…Previous works have shown conflicting results due to the methodology and mostly the profound effect of confounding risk factors. [2][3][4][5][6][7] Fortunately in the present study the results are robust even after adjusting for major parameters such as age, smoking, glycaemic, lipid and blood pressure status. In a recent meta-analysis, incorporating the results of 41 well-designed and performed studies showed the link of coronary artery disease with opium use, whereas there was no direct link to inhospital mortality.…”

“…Historically there was the erroneous notion that there are beneficial health effects related to opium use but emerging data are towards the other direction. [2][3][4][5] In the present study, the authors used a registry database of 28,691 patients who underwent the procedure from 2007 to 2016, covering almost a decade of surgical practice. 1 It was revealed that persistent opium consumption after CABG not only did not ameliorate the overall outcome but it was associated with 28% increased risk of 5-year mortality compared with never opium consumers.…”

“…Previously it was shown that subjects free of cardiovascular disease who start a new opioid prescription have a 99% increased risk of incident cardiovascular disease. 5 Whether opioid use, by promoting a more unhealthy lifestyle characterized by lack of exercise, tobacco smoking, eating behaviours, interacts with hypertension, diabetes mellitus and hypertension to cause cardiovascular events remains speculative and further research on these pathophysiological mechanisms is needed.…”

Editors’ presentation: Focus on diabetes mellitus and diet

“…Over the past few years, multiple clinical and animal evidence has clarified that opium consumption not only does not confer a beneficial effect in improving glycaemic control and lipid profile and preventing CVD, but also it may aggravate metabolic disturbances and increase the risk of CVD, especially in patients with post-traumatic stress disorder. 19 However, very little is known about the effect of persistent opium consumption after surgery on the outcomes after coronary artery bypass grafting (CABG). In the present issue of the journal, authors using a registry database of 28,691 patients who underwent CABG revealed that persistent opium consumption after CABG not only did not ameliorate the overall outcome but it was associated with a 28% increased risk of 5-year mortality compared with never opium consumers.…”