Opium Consumption and Coronary Atherosclerosis in Diabetic Patients: A Propensity Score-Matched Study

Abstract

There is a traditional belief among Eastern people that opium may have ameliorating effects on cardiovascular risk factors, especially diabetes; thus, it is widely used among diabetic patients. We attempted to investigate the association of opium consumption with coronary artery disease (CAD) in diabetic patients. A cross-sectional study was conducted on diabetic patients undergoing coronary angiography in our center. Out of 1925 diabetic patients included in the study, 228 were opium users, and the remaining 1697 non-opium users were used as a pool of potential comparators. Propensity scores were used to match the 228 opium consumers with 228 matched comparators for age, sex, and smoking status. The Gensini score and extent score were respectively used to assess the angiographic severity and extent of CAD. The mean Gensini score (86.9 ± 62.7 vs. 59.6 ± 43.4, p < 0.0001) and extent score (7.1 ± 2.9 vs. 5.9 ± 2.9, p < 0.0001) were significantly higher in opium user diabetic patients than in non-opium users. After adjustment for potential confounders, a dose-response relationship was observed between dose of opium and the Gensini score (β = 0.27, p = 0.04). There were no significant differences between the routes of opium administration (inhalation vs. oral) regarding the severity and extent of CAD. In conclusion, exposure to opium in diabetic patients may be positively associated with the risk of CAD, and with the angiographically determined severity and extent of the disease. Furthermore, dosage of opium consumption may correlate with severity of CAD.

Key words

Papaver somniferum - Papaveraceae - opium - diabetes mellitus - atherosclerosis

References

• 1 Colagiuri R. Diabetes: a pandemic, a development issue or both?.  Expert Rev Cardiovasc Ther. 2010;  8 305-309
• 2 Prevention of diabetes mellitus. Report of a WHO study group.  World Health Organ Tech Rep Ser. 1994;  844 1-100
• 3 Kulsudjarit K. Drug problem in southeast and southwest Asia.  Ann NY Acad Sci. 2004;  1025 446-457
• 4 Karbakhsh M, Salehian Zandi N. Acute opiate overdose in Tehran: the forgotten role of opium.  Addict Behav. 2007;  32 1835-1842
• 5 Mohammadi A, Darabi M, Nasry M, Saabet-Jahromi M J, Malek-Pour-Afshar R, Sheibani H. Effect of opium addiction on lipid profile and atherosclerosis formation in hypercholesterolemic rabbits.  Exp Toxicol Pathol. 2009;  61 145-149
• 6 Karam G A, Reisi M, Kaseb A A, Khaksari M, Mohammadi A, Mahmoodi M. Effects of opium addiction on some serum factors in addicts with non-insulin-dependent diabetes mellitus.  Addict Biol. 2004;  9 53-58
• 7 Sadr Bafghi S M, Rafiei M, Bahadorzadeh L, Namayandeh S M, Soltani M H, Motafaker M, Andishmand A. Is opium addiction a risk factor for acute myocardial infarction?.  Acta Med Iran. 2005;  43 218-222
• 8 Farahani M A, Mohammadi E, Ahmadi F, Maleki M, Hajizadeh E. Cultural barriers in the education of cardiovascular disease patients in Iran.  Int Nurs Rev. 2008;  55 360-366
• 9 Marmor M, Penn A, Widmer K, Levin R I, Maslansky R. Coronary artery disease and opioid use.  Am J Cardiol. 2004;  93 1295-1297
• 10 Azimzade-Sarwar B, Yousefzade G, Narooey S. A case-control study of effect of opium addiction on myocardial infarction.  Am J Appl Sci. 2005;  2 1134-1135
• 11 Davoodi G, Sadeghian S, Akhondzadeh S, Darvish S, Alidoosti M, Amirzadegan A. Comparison of specifications, short-term outcome and prognosis of acute myocardial infarction in opium dependent patients and non-dependents.  Ger J Psych. 2005;  8 33-37
• 12 Sadeghian S, Darvish S, Davoodi G, Salarifar M, Mahmoodian M, Fallah N, Karimi A A. The association of opium with coronary artery disease.  Eur J Cardiovasc Prev Rehabil. 2007;  14 715-717
• 13 Joukar S, Najafipour H, Malekpour-Afshar R, Mirzaeipour F, Nasri H R. The effect of passive opium smoking on cardiovascular indices of rabbits with normal and ischemic hearts.  Open Cardiovasc Med J. 2010;  4 1-6
• 14 Najafipour H, Joukar S, Malekpour-Afshar R, Mirzaeipour F, Nasri H R. Passive opium smoking does not have beneficial effect on plasma lipids and cardiovascular indices in hypercholesterolemic rabbits with ischemic and non-ischemic hearts.  J Ethnopharmacol. 2010;  127 257-263
• 15 Chobanian A V, Bakris G L, Black H R, Cushman W C, Green L A, Izzo jr. J L, Jones D W, Materson B J, Oparil S, Wright jr. J T, Roccella E J. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  Hypertension. 2003;  42 1206-1252
• 16 Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).  JAMA. 2001;  285 2486-2497
• 17 Hubert H B, Holford T R, Kannel W B. Clinical characteristics and cigarette smoking in relation to prognosis of angina pectoris in Framingham.  Am J Epidemiol. 1982;  115 231-242
• 18 Hopkins P N, Williams R R. Human genetics and coronary heart disease: a public health perspective.  Annu Rev Nutr. 1989;  9 303-345
• 19 Gensini G G. A more meaningful scoring system for determining the severity of coronary heart disease.  Am J Cardiol. 1983;  51 606
• 20 Negri M, Sheiban I, Arigliano P L, Tonni S, Montresor G, Carlini S, Manzato F. Interrelation between angiographic severity of coronary artery disease and plasma levels of insulin, C-peptide, and plasminogen activator inhibitor-1.  Am J Cardiol. 1993;  72 397-401
• 21 Birnie D H, Holme E R, Mckay I C, Hood S, Mccoll K E, Hillis W S. Association between antibodies to heat shock protein 65 and coronary atherosclerosis. Possible mechanism of action of Helicobacter pylori and other bacterial infections in increasing cardiovascular risk.  Eur Heart J. 1998;  19 387-394
• 22 Oberman A, Jones W B, Riley C, Reeves T J, Sheffield L T, Turner M E. Natural history of coronary artery disease.  Bull NY Acad Med. 1972;  48 1109-1125
• 23 Rosenbaum P R. Observational studies. 2nd edition. New York: Springer-Verlag; 2002
• 24 D'Agostino jr. R B. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.  Stat Med. 1998;  17 2265-2281
• 25 Phillips G B, Pinkernell B H, Jing T Y. The association of hypotestosteronemia with coronary artery disease in men.  Arterioscler Thromb. 1994;  14 701-706
• 26 Asgary S, Sarrafzadegan N, Naderi G A, Rozbehani R. Effect of opium addiction on new and traditional cardiovascular risk factors: do duration of addiction and route of administration matter?.  Lipids Health Dis. 2008;  7 42
• 27 George S, Murali V, Pullickal R. Review of neuroendocrine correlates of chronic opiate misuse.  Addict Disord Their Treatment. 2005;  4 99-109
• 28 Sheldon B H, Quin J D. Diabetes and illicit drug use.  Practical Diabetes Int. 2005;  2005 222-224
• 29 Moshtaghi-Kashanian G R, Esmaeeli F, Dabiri S. Enhanced prolactin levels in opium smokers.  Addict Biol. 2006;  10 345-349
• 30 Sauro M D, Zorn N E. Prolactin induces proliferation of vascular smooth muscle cells through a protein kinase C-dependent mechanism.  J Cell Physiol. 1991;  148 133-138
• 31 Singh S K, Suresh M V, Voleti B, Agrawal A. The connection between C-reactive protein and atherosclerosis.  Ann Med. 2008;  40 110-120
• 32 Danesh J, Lewington S, Thompson S G, Lowe G D, Collins R, Kostis J B, Wilson A C, Folsom A R, Wu K, Benderly M, Goldbourt U, Willeit J, Kiechl S, Yarnell J W, Sweetnam P M, Elwood P C, Cushman M, Psaty B M, Tracy R P, Tybjaerg-Hansen A, Haverkate F, De Maat M P, Fowkes F G, Lee A J, Smith F B, Salomaa V, Harald K, Rasi R, Vahtera E, Jousilahti P, Pekkanen J, D'agostino R, Kannel W B, Wilson P W, Tofler G, Arocha-Pinango C L, Rodriguez-Larralde A, Nagy E, Mijares M, Espinosa R, Rodriquez-Roa E, Ryder E, Diez-Ewald M P, Campos G, Fernandez V, Torres E, Marchioli R, Valagussa F, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Cremer P, Nagel D, Curb J D, Rodriguez B, Yano K, Salonen J T, Nyyssonen K, Tuomainen T P, Hedblad B, Lind P, Loewel H, Koenig W, Meade T W, Cooper J A, De Stavola B, Knottenbelt C, Miller G J, Bauer K A, Rosenberg R D, Sato S, Kitamura A, Naito Y, Palosuo T, Ducimetiere P, Amouyel P, Arveiler D, Evans A E, Ferrieres J, Juhan-Vague I, Bingham A, Schulte H, Assmann G, Cantin B, Lamarche B, Despres J P, Dagenais G R, Tunstall-Pedoe H, Woodward M, Ben-Shlomo Y, Davey Smith G, Palmieri V, Yeh J L, Rudnicka A, Ridker P, Rodeghiero F, Tosetto A, Shepherd J, Ford I, Robertson M, Brunner E, Shipley M, Feskens E J, Kromhout D, Dickinson A, Ireland B, Juzwishin K, Kaptoge S, Memon A, Sarwar N, Walker M, Wheeler J, White I, Wood A. Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis.  JAMA. 2005;  294 1799-1809
• 33 Schmidt C, Fagerberg B. ApoB/apoA–I ratio is related to femoral artery plaques in 64-year-old women also in cases with low LDL cholesterol.  Atherosclerosis. 2008;  196 817-822
• 34 Azod L, Rashidi M, Afkhami-Ardekani M, Kiani G, Khoshkam F. Effect of opium addiction on diabetes.  Am J Drug Alcohol Abuse. 2008;  34 383-388