title: Lifetime opiate exposure as an independent and interactive cardiovascular risk factor in males: a cross-sectional clinical study.
abstract: BACKGROUND
  While several studies have identified an increased incidence of cardiovascular disorders in opiate dependence, neither opiates as a cardiovascular risk factor nor their effect on central arterial function has been considered.
  
  
  METHODS
  Pulse wave analysis (SphygmoCor, AtCorMedical Pty Limited, Sydney, NSW, Australia) was undertaken on a cohort of controls and opiate dependent patients and the results compared to their lifetime opiate exposure.
  
  
  RESULTS
  Controls (N = 401) were compared with 465 opiate dependent men. The mean (log) ages were different and were found to be 28.80 ± 0.49 years versus 35.02 ± 0.39 years (P < 0.0001), respectively. Of the opiate dependent group, 87.7% were treated with buprenorphine, 8.8% with methadone, and 3.4% with naltrexone. Multiple regression analysis was used to adjust for chronologic age (CA). At CA of 60 years, the modeled age in the controls was 66.40 years, and that in the addicted group was 73.11 years, an advancement of 6.71 years, or 10.10%. Exacerbations of age dependent changes in central arterial stiffness, central pressures, pulse rate, ejection duration, diastolic duration, and subendocardial perfusion ratio by opiate dependence were all noted (P < 0.05). Current heroin dose, heroin duration, and the dose duration interaction were all significantly related to the vascular (or "reference") age (RA)/CA ratio (all P < 0.006). After multivariate adjustment, the opiate dose duration was independently predictive of RA (P < 0.02). Opiate dose and/or duration were included in a further 25 terms.
  
  
  CONCLUSIONS
  These data show that opiate use is not benign for the male cardiovascular system, but has a dose response relationship to central arterial stiffness and thus cardiovascular aging, acting independently and interactively with established cardiovascular risk factors. These findings imply accelerated organismal aging.
authors.affiliation: School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia.
authors.forename: Albert S
authors.initials: AS
authors.lastname: Reece
authors.forename: Gary K
authors.initials: GK
authors.lastname: Hulse
mesh_terms: D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D006439:Hemodynamics / Q000187:drug effects; D006556:Heroin Dependence / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058850:Opiate Substitution Treatment; D063177:Pulse Wave Analysis; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D059289:Vascular Stiffness / Q000187:drug effects; D055815:Young Adult
keywords: arterial stiffness; heroin; human aging; methadone; opiate dependence; vascular aging