High cardiovascular risk in older patients with opioid use disorder: Differences with the general population

Abstract

Introduction Cardiovascular disease is a health concern in ageing population with opioid use disorders (OUD). The study aims to analyse the cardiovascular risk factors in individuals with OUD. Methods An observational study was carried out to compare cardiovascular risk factors of adults >50 years with OUD on methadone therapy from public outpatient drug treatment centres, with that of an age‐ and gender‐matched sample (ratio of 1:5) of subjects from a sample of the Spanish population (REGICOR cohort). High cardiovascular risk (HCVR) at 10 years was defined according to Framingham‐REGICOR and SCORE risk functions. Results The individuals studied included 94 people with OUD and 495 from the general population; the mean age was 55.7 ± 4.8 years and 432 (72.7%) were men. Obesity (21.2% vs. 35.2%), hypertension (26.3% vs. 42.1%), total cholesterol (30.3% vs. 65.4%) and LDL‐cholesterol ≥130 mg/dL (27.2% vs. 59.3%) were significantly more prevalent in the general population group, while tobacco smoking (96.0% vs. 25.9%), low HDL‐cholesterol (46.5% vs. 21.2%), hypertriglyceridaemia (39.4% vs. 18.8%) and atherogenic dyslipidaemia (30.3% vs. 10.5%) were significantly higher in individuals with OUD. Differences in abdominal obesity (62.6% vs. 65.3%) were not significant. HCVR was more prevalent in patients with OUD: 15.2% versus 5.8% (Framingham‐REGICOR function) and 21.2% versus 11.3% (SCORE function). Discussion and Conclusions Older adults with OUD on methadone therapy have a different prevalence of cardiovascular risk factors and HCVR than the general population. Preventive measures, particularly tobacco smoking cessation and weight control, should be included in the routine care of individuals with OUD.

Prevalence and Risk Factors of Hypertension among Patients with Opioid Use Disorder in Methadone Maintenance Treatment

“…Similarly, in addition to having a higher BMI, the HTN group was characterized as having negative urine results for all tested substances. Vallecillo et al 7 showed a lower HRN rate as well as a lower BMI among the MMT group members, suggesting an association between these 2 variables, namely, that if BMI is lower than BP is lower, and vice versa. While substance usage was not reported in that study, we assume that it is associated with behavior incompatible with weight gain, which prevents HTN.…”

“…Similarly, in addition to having a higher BMI, the HTN group was characterized as having negative urine results for all tested substances. Vallecillo et al 7 evaluated cardiovascular risk factors among elderly (≥50 years) patients in MMT in comparison to an age-matched general population in Spain. Although those authors found several risk factors among the MMT group members, their results showed a lower HRN rate as well as a lower BMI among the MMT group members, suggesting an association between these 2 variables, namely, that if BMI is lower than BP is lower, and vice versa.…”

“…In contrast, an observational study that compared cardiovascular risk factors of 94 adults >50 years of age with opioid use disorder on MMT with that of an age- and sex-matched sample (ratio of 1:5) of subjects from a sample of the Spanish population found that HTN and obesity were significantly more prevalent in the general population group. 7 Another study that compared medication dispensing between MMT patients to age-matched controls from the general population 8 found that the MMT group was significantly more likely to receive medications for chronic obstructive pulmonary disease (odds ratio [OR] = 32.68, P <0.001) and depression (OR = 4.07, P <0.001), and no significant differences for HTN (OR = 0.86) or diabetes mellitus (OR = 0.74). Following onsite health screening and brief health counseling for patients receiving MMT at the Atlanta Veterans Affairs Medical Center, 11 several factors were reported to have improved, but not the prevalence of uncontrolled HTN (38% before vs. 28% after, P =0.34).…”

“…[1][2][3] While obesity and weight gain were consistently reported among patients receiving MMT, [4][5][6] the same did not hold true concerning hypertension (HTN). [7][8][9] In a pilot study aimed to evaluate geriatric conditions among MMT in comparison with a representative sample of community-dwelling older adults, the most common chronic disease of the 47 adults on MMT (mean age 58.8 years) was HTN 9 (59.6%). Likewise, in a large study among 1000 MMT patients in NY, 50% reportedly had HTN 10 .…”

Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study

“…A recent registry study from Scotland found a high co-presence of respiratory and cardiovascular disease from autopsies for opioid-specific drug-related deaths (DRD) and the authors concluded that circulatory disease was likely related to the quadrupling of methadone-specific DRD in the age group 45 and older [[52]]. Another recent study found older OMT patients to have high cardiovascular risks compared to a gender- and age-matched sample from general populations [[53]].…”