Abstract
Abstract
Background
Chronic opioid exposure (COE) is linked to adverse health outcomes, but its relationship with cardiovascular disease (CVD) remains unclear. This systematic review and meta-analysis examined CVD risk associated with COE, including prescription opioids, opium use, and opioid use disorder (OUD).
Methods
Following PRISMA guidelines and PROSPERO registration, we comprehensively searched multiple databases for relevant human studies reporting associations between COE and CVD. Random-effects meta-analysis estimated pooled odds ratios (OR) with 95% confidence intervals. Subgroup analyses and meta-regression explored associations by COE type, CVD outcome, and potential moderators.
Results
Seventeen studies (1,676,000 participants) met inclusion criteria, with 13 studies contributing 22 effect sizes to meta-analysis. COE was associated with increased CVD risk (pooled log OR: 0.56, 95% CI: 0.12–0.99), though substantial heterogeneity was observed. Cerebrovascular accidents (log OR: 0.61, 95% CI: 0.37–0.85) and ischaemic heart disease (log OR: 0.41, 95% CI: 0.34–0.49) showed the strongest associations. Opium use had a significant association with CVD, while findings for OUD and prescription opioids were less consistent. Meta-regression identified study design as a key moderator.
Conclusion
COE is associated with increased risk of CVD, particularly cerebrovascular accidents and ischaemic heart disease. Given the global opioid and CVD burden, targeted interventions and integrated care approaches are needed. Further high-quality research should explore pathophysiological mechanisms, causality, dose-response relationships, and the potential reversibility of CVD risk following opioid cessation.
Background
Chronic opioid exposure (COE) is linked to adverse health outcomes, but its relationship with cardiovascular disease (CVD) remains unclear. This systematic review and meta-analysis examined CVD risk associated with COE, including prescription opioids, opium use, and opioid use disorder (OUD).
Methods
Following PRISMA guidelines and PROSPERO registration, we comprehensively searched multiple databases for relevant human studies reporting associations between COE and CVD. Random-effects meta-analysis estimated pooled odds ratios (OR) with 95% confidence intervals. Subgroup analyses and meta-regression explored associations by COE type, CVD outcome, and potential moderators.
Results
Seventeen studies (1,676,000 participants) met inclusion criteria, with 13 studies contributing 22 effect sizes to meta-analysis. COE was associated with increased CVD risk (pooled log OR: 0.56, 95% CI: 0.12–0.99), though substantial heterogeneity was observed. Cerebrovascular accidents (log OR: 0.61, 95% CI: 0.37–0.85) and ischaemic heart disease (log OR: 0.41, 95% CI: 0.34–0.49) showed the strongest associations. Opium use had a significant association with CVD, while findings for OUD and prescription opioids were less consistent. Meta-regression identified study design as a key moderator.
Conclusion
COE is associated with increased risk of CVD, particularly cerebrovascular accidents and ischaemic heart disease. Given the global opioid and CVD burden, targeted interventions and integrated care approaches are needed. Further high-quality research should explore pathophysiological mechanisms, causality, dose-response relationships, and the potential reversibility of CVD risk following opioid cessation.
| Original language | English |
|---|---|
| Article number | 10.1093/eurjpc/zwaf500 |
| Journal | European Journal of Preventive Cardiology |
| DOIs | |
| Publication status | Published - 9 Aug 2025 |
Keywords
- Opioids, opium, opioid use disorder, cardiovascular disease, systematic review, meta-analysis
