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Opioid use linked to increased AF risk in young veterans
CHICAGO — Young and middle-aged veterans with a history of opioid use were 34% more likely to develop atrial fibrillation, according to data presented at the American Heart Association Scientific Sessions.
The findings come from an analysis of U.S. medical records, including opioid prescriptions from 2014 to 2015, of more than 850,000 post-9/11 veterans.
There is mounting evidence that opioids can cause CV damage; however, the mechanisms by which these medications promote CVD remain poorly understood.
“Opioid use was recently associated with cardiovascular mortality [in other research]. The reasons and mechanism of this association are unclear, so we thought to investigate if there is an association between opioid use and atrial fibrillation. Veterans are known to use opioids at a greater rate than the general population, making this a particularly important issue in this population,” Jonathan Stock, MD, resident physician at Yale-New Haven Hospital, told Cardiology Today.
Overall, 3,033 (0.4%) of veterans included in this study had a diagnosis of AF. Among those with AF, nearly 29% had taken opioids, compared with 15% of those who did not have an AF diagnosis.
Prescription of an opioid was independently associated with the likelihood of AF, even after the researchers adjusted for demographic, medical and mental health factors (OR = 1.34; 95% CI, 1.23-1.45).
No significant trend emerged with duration of opioid prescription and AF prevalence. The study also assessed opioid use overall, and did not look at associations with specific medications.
A concerning finding, according to the researchers, was the occurrence of AF in this relatively young, healthy population. The mean age of veterans in this study was 38 years. Additionally, 13% were women, 59% were white, 14% were black and 11% were Hispanic.
The researchers cautioned that this study focused on tracking opioid use, rather than opioid abuse.
“It is much more difficult to study an association like this in patients with opioid abuse rather than use because it is hard to determine what amount of use would constitute abuse. We thought that investigating use alone would perhaps be more insightful regarding the dangers of these drugs,” Stock told Cardiology Today.
Although this study did not analyze the biological mechanisms by which opioids can induce arrhythmia disorders, the researchers said one possible explanation could be that opioids can lead to sleep-disordered breathing and obstructive sleep apnea. Further research is needed to deduce the biological mechanisms underlying the association between CVD and opioid use, Stock and colleagues said.
“The take-home message is that opioids may be causing more harm than we think, even with all the attention that is focused on the epidemic of opioid abuse. As physicians, we should do everything we can to ensure we prescribe these medications only when absolutely necessary,” Stock told Cardiology Today. – by Katie Kalvaitis
Reference:
Stock J, et al. Poster Sa1079. Presented at: American Heart Association Scientific Sessions; Nov. 10-12, 2018; Chicago.
Disclosure: The study was supported by the Veterans Health Administration. Stock reports no relevant financial disclosures.