Background: The rising opioid epidemic in the United States has been linked to higher cardiovascular disease (CVD) mortality although the mechanism for this association remains unclear. We investigated whether prescription opioid usage is associated with the prevalence of CVD and risk factors in a young Veteran population that have few comorbidities at baseline and at risk for prescription opioid usage.
Methods: We utilized a Veterans Affairs administrative and clinical database of Veterans who were deployed to or served in support of the wars in Iraq or Afghanistan. We extracted information on patient demographics, self-reported race, and clinical comorbidities using ICD-9 codes. Veterans were classified as using opioids for an intermediate duration if they were on prescription opioids for more than 30 and less than 90 days and chronic duration if more than 90 days between 2014 and 2015. We then utilized logistic regression to determine the association of intermediate duration and chronic duration of prescription opioid usage on CVD and risk factors (dyslipidemia, hypertension, diabetes, coronary artery disease, and atrial fibrillation) controlling for patient demographics, psychiatric, and other medial comorbidities.
Results: Of the 1,1085,016 Veterans who met inclusion for our study, the mean age was 38 and 12% were female. Within our study period, 3.3% of Veterans were on prescription opioids for an intermediate duration and 4.0% were on prescription opioids for a chronic duration. After adjustment, Veterans on prescription opioids for an intermediate and chronic duration were at higher odds of having dyslipidemia, hypertension, diabetes, coronary artery disease, and atrial fibrillation [Table].
Conclusion: A significant minority of Veterans serving or returning from recent deployment is on extended duration of opioids and has a higher likelihood of having cardiovascular risk factors and disease. Our results suggest that the association of CVD mortality with opioid usage may be explained by patients on opioids with increased odds of having CVD risk factors. Future prospective studies are warranted to determine if declines in prescription opioid usage in a relatively young population may reduce risk of developing CVD in later decades.