title: Prescription Opioid Use and Risk of Coronary Heart Disease, Stroke, and Cardiovascular Death Among Adults from a Prospective Cohort (REGARDS Study).
abstract: Despite unknown risks, prescription opioid use (POU) for nonmalignant chronic pain has grown in the US over the last decade. The objective of this study was to examine associations between POU and coronary heart disease (CHD), stroke, and cardiovascular disease (CVD) death in a large cohort.
  
  
  
  POU was assessed in the prospective cohort study of 29,025 participants of the REasons for Geographic and Racial Differences in Stroke study, enrolled between 2003 and 2007 from the continental United States and followed through December 31, 2010. CHD, stroke, and CVD death were expert adjudicated outcome measures.
  
  
  
  Cox proportional hazards models adjusted for CVD risk factors were used.
  
  
  
  Over a median (SD) of 5.2 (1.8) years of follow-up, 1,362 CHD events, 749 strokes, and 1,120 CVD death occurred (105, 55, and 104, respectively, in the 1,851 opioid users). POU was not associated with CHD (adjusted hazard ratio [aHR]) 1.03 [95% CI 0.83-1.26] or stroke (aHR 1.04 [95% CI 0.78-1.38]), but was associated with CVD death (aHR 1.24 [95% CI 1.00-1.53]) in the overall sample. In the sex-stratified analyses, POU was associated with increased risk of CHD (aHR 1.38 [95% CI 1.05-1.82]) and CVD death (aHR 1.66 [95% CI 1.27-2.17]) among females but not males (aHR 0.70 [95% CI 0.50-0.97] for CHD and 0.78 [95% CI 0.54-1.11] for CVD death).
  
  
  
  Female but not male POU were at higher risk of CHD and CVD death. POU was not associated with stroke in overall or sex-stratified analyses.
authors.affiliation: *Department of Medicine, School of Medicine, University of Alabama at Birmingham khodneva@uab.edu.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Khodneva
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: *Department of Medicine, School of Medicine, University of Alabama at Birmingham.|Birmingham Veterans Administration Health Center.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kertesz
authors.affiliation: Department of Neurology, School of Medicine, University of Cincinnati.
authors.forename: Brett
authors.initials: B
authors.lastname: Kissela
authors.affiliation: *Department of Medicine, School of Medicine, University of Alabama at Birmingham.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality*; D015331:Cohort Studies; D003327:Coronary Disease / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality*
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs
keywords: Cardiovascular Disease; Opioids; Sex Differences