Coronary heart disease outcomes among chronic opioid and cyclooxygenase-2 users compared with a general population cohort

Authors


  • Research was conducted at i3 Drug Safety, Ann Arbor, MI, USA.

W. J. Carman, i3 Drug Safety, 5430 Data Court, Suite 200, Ann Arbor, MI 48108, USA. E-mail: wendy.carman@i3drugsafety.com

ABSTRACT

Background

We estimated the incidence of myocardial infarction (MI) and coronary revascularization (CR) among users of chronic opioid therapy (COT) and compared risks across categories of morphine-equivalent doses of COT and comparator cohorts.

Methods

We conducted a retrospective claims-based study using de-identified data from a commercially insured population. A cohort of 148 657 adult users of COT, a matched cohort of the general population, and three cohorts of users of chronic cyclooxygenase-2 (COX-2) inhibitor therapy totaling 122 810 were identified. Incidence rates and incidence rate ratios (IRRs) of MI and MI/CR were estimated.

Results

Adjusted IRRs for MI ranged from 1.21 (95% confidence interval [95%CI], 1.02–1.45) among those receiving low COT doses to 1.89 (95%CI, 1.54–2.33) among those receiving high doses compared with those receiving very low doses, averaging <15 mg/day. Similar patterns were shown for MI/CR. IRRs standardized to the age–sex distribution of the general cohort and adjusted for coronary heart disease risk factors showed 2.7 times the rate of MI and 2.4 times the rate of MI/CR in the COT cohort compared with the general population. Using the same analysis, COX-2 users had 1.7–1.9 times the rate of MI and MI/CR compared with the general cohort.

Conclusions

Chronic analgesic use with either COT or COX-2 was associated with an increased risk of cardiovascular outcomes. These findings suggest either a selection of high-risk patients to chronic analgesic treatment, coupled with unmeasured or residual confounding, or a potential cardiovascular effect of these medications. Further research is warranted to evaluate causes for this association. Copyright © 2011 John Wiley & Sons, Ltd.

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