Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study

Abstract

Introduction: In 2019, Scotland reported the highest number of drug deaths amongst EU countries. Of the 1,264 drug deaths reported in 2019, 94% were related to polysedative use. Studies have proposed a relationship between opioid use and cardiovascular disease. Furthermore, the concomitant use of sedatives and opioids has been associated with lethal cardiopulmonary events. However, evidence is still limited for the relationship between polysedative use and cardiovascular diseases. Thus, the present study aimed to investigate the association between polysedative use and the underlying cardiovascular pathologies in drug deaths.Methods: This study consisted of a post-mortem investigation of 436 drug deaths. Data extracted from post-mortem reports included socio-demographic characteristics (e.g., gender, age), cardiovascular pathologies (e.g., atherosclerosis, atheroma, and inflammation), in addition to the presence of opioids (e.g. methadone, heroin) and other substances (e.g., alcohol, benzodiazepine) in the blood of the deceased. Stepwise multiple regression models were employed to identify which substances predicted cardiovascular pathologies.Results: The presence of opioids, benzodiazepines, and alcohol in the blood of the deceased predicted overall cardiovascular disease (CVD) severity [R2 = 0.33, F (5, 430) = 39.64, p < 0.0001; adjusted R2 = 0.32, f2 = 0.49]. Positive Beta coefficients may indicate an exacerbation of CVD (B = 0.48 95% CI = 0.25, 0.70) due to the presence of opioids in the blood of the deceased. Negative associations may instead indicate a relative protective effect of alcohol (B = −0.2, 95% CI = −0.41, −0.00) and benzodiazepines (B = −0.29, 95% CI = −0.48, −0.09) on CVD.Conclusion: These findings may inform national clinical guidelines on the need to monitor individuals who abuse opioids for presence of cardiovascular disease risk factors pathologies and provide timely interventions to reduce mortality in the population.

Opioid Impacts on Cardiovascular Health

“…Vascular pathologies examined included the presence and extent of atherosclerosis, atheroma, fibrosis, hypertrophy, inflammation, and stenosis. There was an association between the presence of opioids in the system of the post-mortem reports and the total CVD severity level consistent with a significant relationship between opioids and CVD pathologies with inflammation and atheroma leading to atherosclerosis [ 47 ].…”

“…Delving into the underlying causes of CAD and CVD, a patient’s post-mortem reports analysis study focused on mortality’s relation to opioid use [ 47 ]. This study had a sample of 436 individuals who had died due to CVD pathologies.…”

Post‐mortem redistribution of drugs and other factors affecting interpretation: A review

“…Examples include the presence of potentially toxic concentrations of a drug in a person with pre‐existing lung or heart disease. For example, benzodiazepines and opioids can be more toxic if misused in a person with significant lung disease (Ray et al, 2021), opioids are strongly associated with cardiovascular disease (Arab et al, 2021) as are the strong stimulants such as methamphetamine and cocaine (Darke et al, 2018; Lucena et al, 2010; Pilgrim et al, 2009).…”