Trends in opioid use among adults with cardiovascular disease, 2001 - March 2020

Opioids can cause adverse cardiovascular effects (e.g., hypotension, arrhythmias), which can be concerning in individuals with pre-existing cardiovascular disease (CVD). Currently, little is known regarding the trends in opioid use among individuals with CVD.

To evaluate the long-term trends of prescription opioids among adults with CVD in the United States.

Using National Health and Nutrition Examination Survey data from 2001 to March 2020, adults ≥20 year old with ≥1 of the following CVDs - heart failure, coronary heart disease, angina, myocardial infarction, and stroke - were identified. Trends in the use of any, short-term (≤90 days), and long-term (>90 days) prescription opioids were evaluated. Subgroup analyses were conducted to test trends in any prescription opioid use by CVD types, pain-related comorbidities, and demographic/socioeconomic characteristics. Multivariable logistic regression, adjusted for age, was used to test the trends in 4-year examination periods.

Among 6250 participants with CVD, no significant trends in the use of any prescription opioids were observed throughout the study period (9.4% in 2001-2004% to 11.8% in 2017-March 2020; P = 0.25). The prevalence of long-term prescription opioid use increased from 6.6% in 2001-2004% to 10.4% in 2017-March 2020, with a peak prevalence of 12.6% in 2013-2016 (P = 0.04). During the study period, an increase in the prevalence of any prescription opioid use was seen among individuals aged ≥65 years, from 7.5% in 2001-2004% to 11.3% in 2017-March 2020 (P = 0.006).

Although overall prescription opioid use among participants with CVD remained relatively consistent between 2001 and March 2020, the use of long-term opioid prescriptions increased, possibly reflecting a growing burden of chronic pain in this population. Prescription opioid use also appeared to have increased among individuals aged ≥65 years, raising concerns due to their heightened risk of cardiovascular adverse effects from opioids.