Association between chronic opioid exposure and cardiovascular disease: a systematic review and meta-analysis.
Joe Schofield, Aldo Alberto Conti, Faisel Khan et al.
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In 30 seconds
This systematic review and meta-analysis examined associations between chronic opioid exposure—including opium use, opioid use disorder, and prescription opioids—and cardiovascular disease in human studies. Seventeen studies involving 1 676 000 participants were included, with 13 studies contributing to the pooled analysis. Chronic opioid exposure was associated with higher cardiovascular disease odds (pooled OR, 1.74; 95% CI, 1.12-2.70), with the strongest associations reported for cerebrovascular accidents and ischaemic heart disease. Results varied across exposure types, and substantial heterogeneity was observed.
Key findings
- Chronic opioid exposure was associated with cardiovascular disease (pooled OR, 1.74; 95% CI, 1.12-2.70).
- Cerebrovascular accidents were associated with opioid exposure (OR, 1.84; 95% CI, 1.45-2.35).
- Ischaemic heart disease was associated with opioid exposure (OR, 1.51; 95% CI, 1.40-1.63).
- Associations were significant for opium use, while findings for opioid use disorder and prescription opioids were less consistent.
Why it matters
The findings indicate that chronic opioid exposure may identify a population with elevated cardiovascular risk, particularly for cerebrovascular and ischaemic heart disease. This is relevant to cardiovascular risk assessment in the context of opioid exposure, while the observational evidence and substantial heterogeneity mean the results do not establish that opioids cause these outcomes.
What to keep in mind
The authors report substantial heterogeneity and risk of bias in the included studies; most studies were non-randomized, limiting causal interpretation.