Chronic opioid use for noncancer pain and risk of cardiovascular events: a National Health Insurance database analysis.

OBJECTIVE

Although opioids primarily act on the central nervous system, they also affect the cardiovascular (CV) system. This study aimed to examine the association between long-term opioid use and the risk of CV events in individuals with noncancer pain.

METHODS

We conducted a nationwide observational cohort study using data from the Korean National Health Insurance Service, linked to the national health check-up database, between 2009 and 2018. Patients prescribed opioids for ≥90 days were defined as chronic users. After 1:10 propensity score matching, Cox proportional hazards models were used to estimate the risk of myocardial infarction (MI) and ischaemic stroke (IS), reported as hazard ratios (HRs) with 95% confidence intervals (CIs), compared to nonopioid users.

RESULTS

The final analysis included 36 300 opioid users and 334 590 matched controls. Chronic opioid use was significantly associated with increased risk of MI (HR 1.20, 95% CI: 1.12-1.30; P  = 0.001) and IS (HR 1.16, 95% CI: 1.12-1.21; P  < 0.001). Subgroup analyses indicated that the association between opioid use and CV events varied by factors such as prior major CV diseases, anticoagulant use, area of residence, and gabapentinoid use.

CONCLUSION

Long-term opioid use in patients with noncancer pain is associated with an increased risk of CV events. These findings underscore the need for careful CV risk assessment when initiating or maintaining chronic opioid treatment.