title: Opium addiction as an independent risk factor for coronary microvascular dysfunction: A case-control study of 250 consecutive patients with slow-flow angina.
abstract: BACKGROUND
  Approximately 20% to 30% of patients who undergo coronary angiography for assessment of typical cardiac chest pain display microvascular coronary dysfunction (MCD). This study aimed to determine potential relationships between baseline clinical characteristics and likelihood of MCD diagnosis in a large group of patients with stable angina symptoms, positive exercise test and angiographic ally normal epicardial coronary arteries.
  
  
  METHODS
  This cross-sectional study included 250 Iranian with documented evidence of cardiac ischemia on exercise testing, class I or II indication for coronary angiography, and either: (1) angiographically normal coronary arteries and diagnosis of MCD with slow-flow phenomenon, or (2) normal angiogram and no evidence of MCD. All patients completed a questionnaire designed to capture key data including clinical demographics, past medical history, and social factors. Data was evaluated using single and multivariable logistic regression models to identify potential individual patient factors that might help to predict a diagnosis of MCD.
  
  
  RESULTS
  125 (11.2% of total) patients were subsequently diagnosed with MCD. 125 consecutive control subjects were selected for comparison. The mean age was similar among the two groups (52.38 vs. 53.26%, p=ns), but there was a higher proportion of men in the study group compared to control (42.4 vs. 27.2%, p=0.012). No significant relationships were observed between traditional cardiovascular risk factors (diabetes, hypertension, and dyslipidemia) or body mass index (BMI), and likelihood of MCD diagnosis. However, opium addiction was found to be an independent predictor of MCD on single and multivariable logistic regression model (OR=3.575, 95%CI: 1.418-9.016; p=0.0069).
  
  
  CONCLUSIONS
  We observed a significant relationship between opium addiction and microvascular angina. This novel finding provides a potential mechanistic insight into the pathogenesis of MCD with slow-flow phenomenon.
authors.affiliation: Dept. of Cardiology, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. Electronic address: dr_esmaeili_n@yahoo.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Esmaeili Nadimi
authors.affiliation: Dept. of Cardiology, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
authors.forename: Farah
authors.initials: F
authors.lastname: Pour Amiri
authors.affiliation: Dept. of Social Medicine and Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Sheikh Fathollahi
authors.affiliation: Molecular Medicine Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
authors.forename: Gholamhossien
authors.initials: G
authors.lastname: Hassanshahi
authors.affiliation: Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Ahmadi
authors.affiliation: Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
authors.forename: Ahmad Reza
authors.initials: AR
authors.lastname: Sayadi
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D017566:Microvascular Angina / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008875:Middle Aged; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D009293:Opioid-Related Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D009892:Opium / Q000009:adverse effects; D012307:Risk Factors
chemical_list: D009892:Opium
keywords: Angiography; Coronary microvascular dysfunction; Opium; Risk factors; Slow-flow angina