Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Yale School of Medicine, New Haven, CT, United States of America.
Yale School of Medicine, New Haven, CT, United States of America.
Prev Med. 2020 May;134:106036. doi: 10.1016/j.ypmed.2020.106036. Epub 2020 Feb 22.
Reports indicate that long-term opioid therapy is associated with cardiovascular disease (CVD). Using VA electronic health record data, we measured the impact of opioid use on the incidence of modifiable CVD risk factors. We included Veterans whose encounter was between October 2001 to November 2014. We identified Veterans without CVD risk factors during our baseline period, defined as the date of first primary care visit plus 365 days. The main exposure was opioid prescriptions (yes/no, long-term (i.e. ≥90 days) vs no opioid, and long-term vs short-term (i.e. <90 days)), which was time-updated yearly from the end of the baseline period to February 2015. The main outcome measures were incident CVD risk factors (hypertension, dyslipidemia, diabetes, obesity, and current smoking). After excluding prevalent CVD risk factors, we identified 308,015 Veterans. During the first year of observation, 12,725 (4.1%) Veterans were prescribed opioids, including 2028 (0.6%) with long-term exposure. Compared to patients without opioid use, Veterans with opioid use were more likely to have CVD risk factors. Those with long-term exposure were at higher risk of having hypertension (adjusted average hazards ratio [HR] 1.45, 99% confidence interval [CI] 1.33-1.59), dyslipidemia (HR 1.45, 99% CI 1.35-156), diabetes (HR 1.30, 99% CI 1.07-1.57), current smoking status (HR 1.34, 99% CI 1.24-1.46), and obesity (HR 1.22, 99% CI 1.12-1.32). Compared to short-term exposure, long-term had higher risk of current smoking status (HR 1.12, 99% CI 1.01-1.24). These findings suggest potential benefit to screening and surveillance of CVD risk factors for patients prescribed opioids, especially long-term opioid therapy.
报告表明，长期使用阿片类药物与心血管疾病（CVD）有关。利用退伍军人事务部（VA）电子健康记录数据，我们衡量了阿片类药物使用对可改变的 CVD 风险因素的发生率的影响。我们纳入了在 2001 年 10 月至 2014 年 11 月期间有就诊记录的退伍军人。我们确定了在基线期间没有 CVD 风险因素的退伍军人，基线期定义为首次初级保健就诊日期加 365 天。主要暴露因素是阿片类药物处方（是/否，长期（即≥90 天）与无阿片类药物，以及长期与短期（即<90 天）），从基线期末到 2015 年 2 月，每年按时间更新。主要结果是 CVD 风险因素（高血压、血脂异常、糖尿病、肥胖和当前吸烟）的发生。在排除已存在的 CVD 风险因素后，我们确定了 308015 名退伍军人。在观察的第一年，有 12725 名（4.1%）退伍军人被开了阿片类药物处方，其中 2028 名（0.6%）有长期暴露。与未使用阿片类药物的患者相比，使用阿片类药物的退伍军人更有可能出现 CVD 风险因素。长期暴露的退伍军人发生高血压的风险更高（调整后的平均危害比[HR]1.45，99%置信区间[CI]1.33-1.59）、血脂异常（HR 1.45，99%CI 1.35-156）、糖尿病（HR 1.30，99%CI 1.07-1.57）、当前吸烟状态（HR 1.34，99%CI 1.24-1.46）和肥胖（HR 1.22，99%CI 1.12-1.32）。与短期暴露相比，长期暴露的退伍军人当前吸烟状态的风险更高（HR 1.12，99%CI 1.01-1.24）。这些发现表明，对服用阿片类药物的患者进行 CVD 风险因素的筛查和监测可能会带来益处，尤其是长期阿片类药物治疗。
