“Substance use disorders = bad. Overdose = bad”
These relationships are drilled into us as very junior learners, and often even before medical school.
The British Columbia Center for Disease Control (CDC) has analyzed data from a cohort of nearly 800 000 randomly selected patients. (Disclosure: I am on the analytic and writing committees) The team has demonstrated that patients with substance use disorders (alcohol, stimulant, opioid) have a hazard ratio of 1.7 for developing new cardiovascular illnesses (myocardial infarction, stroke, dysrhythmias, and hypertension) over longitudinal follow-up than patients without substance use disorders.
This was adjusted for:
- Smoking history,
- Coincident mental health diagnosis, and
- Social assistance.
Given that the median age was 45y/o and this was only over a 4-year follow-up period, these trends are worrisome! The highest hazards were found among patients with opioid and stimulant use disorder (Gan, Drug Alcohol Depend in press 2021). Using the same cohort, over 5200 patients had a drug overdose, mainly opioids. Patients with overdose had an odds ratio of 2.9 for a new cardiovascular diagnosis (as above) on the date of overdose, and this risk decreased to baseline by the fifth post-overdose day.
In particular, the risk of arrhythmia (odds ratio 8.6) stroke (odds ratio 5.3), and myocardial infarction (odds ratio 3.0) were elevated (Gan, Clin Res Cardiol 2021 in press).
Please be careful when assessing patients with an overdose!
Just something extra to worry about for patients, families, and clinicians…
Have you struggled with this issue?
We want to hear from you! Comment below or contact me.
What is your experience with cardiovascular illnesses related to patients with opioid and stimulant use disorder?
What are your main worries when caring for a patient with a history of substance abuse?
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