title: Opium decreases the age at myocardial infarction and sudden cardiac death: a long- and short-term outcome evaluation.
abstract: BACKGROUND
  Opium dependence is a recognized individual and public health threat, but little is known about its association with acute myocardial infarction (AMI) or sudden cardiac death (SCD).
  
  
  METHODS
  In a cross-sectional study followed by a one-year matched longitudinal cohort, all 569 men hospitalized with AMI in all Cardiac Care Units (CCU) of Isfahan, Iran, were recruited in a six-month period. In addition, 123 out-of-hospital deaths were included that were diagnosed as SCD at the same duration. Among those discharged alive, 126 opium dependents were matched with 126 nondependents (mostly nonusers) according to age and smoking status, and were followed for one year. Opium dependence was measured using the ICD10 criteria and Severity of Dependence Scale (SDS) questionnaire. The method was validated by morphine blood levels. Biochemical measurements, blood pressure, blood cell counts, anthropometrics, and ejection fraction were measured at baseline and repeated at the end of follow-up.
  
  
  RESULTS
  There were 118 (17.1%) patients with an average of 17.4 ± 10.4 years of abuse who met the criteria for opium dependency. Opium dependence decreased the age at event by 3.6 (95% CI: 1.2 - 6.0) years and was independent of smoking (P = 0.003). In terms of cardiovascular risk factors such as ejection fraction, in addition to post-AMI mortality and morbidity, no significant associations were noted at baseline or after one year of follow-up. The odds ratio of sustained smoking after AMI was 1.92 (95% CI: 1.04 - 3.52) in opium dependents (P = 0.033).
  
  
  CONCLUSIONS
  Despite public opinion, opium did not improve cardiovascular risk factors, or post-AMI mortality and morbidity. Conversely, there were irrefutable findings regarding the detrimental effects of opium dependence.
authors: Mental Health Department, Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. talaei@crc.mui.ac.ir.
authors: Hamidreza
authors: H
authors: Roohafza
authors: Mohammad
authors: M
authors: Talaei
authors: Masoumeh
authors: M
authors: Sadeghi
authors: Poone
authors: P
authors: Haghani
authors: Pedram
authors: P
authors: Shokouh
authors: Nizal
authors: N
authors: Sarrafzadegan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D007492:Iran / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D009294:Narcotics / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D009892:Opium / Q000009:adverse effects*; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D009294:Narcotics; D009892:Opium