title: Reduction in arterial stiffness and vascular age by naltrexone-induced interruption of opiate agonism: a cohort study.
abstract: OBJECTIVE
  To prospectively assess if opiate antagonist treatment or the opiate-free status could reverse opiate-related vasculopathy.
  
  
  METHODS
  Longitudinal Open Observational, Serial 'N of One', over 6.5 years under various treatment conditions: opiate dependence, naltrexone and opiate-free.
  
  
  METHODS
  Primary care, Australia.
  
  
  METHODS
  20 opiate-dependent patients (16 males: 16 cases of buprenorphine 4.11±1.17 mg, two of methadone 57.5±12.5 mg and two of heroin 0.75±0.25 g).
  
  
  METHODS
  Studies of central arterial stiffness and vascular reference age (RA) were performed longitudinally by SphygmoCor Pulse Wave Analysis (AtCor, Sydney).
  
  
  METHODS
  Primary outcome was vascular age and arterial stiffness accrual under different treatment conditions.
  
  
  RESULTS
  The mean chronological age (CA) was 33.62±2.03 years. The opiate-free condition was associated with a lower apparent vascular age both in itself (males: p=0.0402 and females: p=0.0360) and in interaction with time (males: p=0.0001 and females: p=0.0004), and confirmed with other measures of arterial stiffness. The mean modelled RA was 38.82, 37.73 and 35.05 years in the opiate, naltrexone and opiate-free conditions, respectively. The opiate-free condition was superior to opiate agonism after full multivariate adjustment (p=0.0131), with modelled RA/CA of 1.0173, 0.9563 and 0.8985 (reductions of 6.1% and 11.9%, respectively).
  
  
  CONCLUSIONS
  Data demonstrate that opiate-free status improves vascular age and arterial stiffness in previous chronic opiate users. The role of opiate antagonist treatment in achieving these outcomes requires future clarification and offers hope of novel therapeutic remediation.
authors.affiliation: Unit for Research and Education in Alcohol and Drugs, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, Perth, Western Australia, Australia.
authors.forename: Albert Stuart
authors.initials: AS
authors.lastname: Reece
authors.forename: Gary Kenneth
authors.initials: GK
authors.lastname: Hulse