Prescribed opioid use is associated with adverse cardiovascular outcomes in community‐dwelling older persons

AIMS: Prescribed opioids are commonly used in the older community‐dwelling population for the treatment of chronic pain. Although the harmful effects of opioid abuse and overdose are well understood, little is known about the long‐term cardiovascular (CV) effects of prescribed opioids. The aim of this study was to investigate the CV effects associated with prescribed opioid use. METHODS AND RESULTS: A post hoc analysis of participants in the Aspirin in Reducing Events in the Elderly (ASPREE) trial was conducted. Participants in the ASPREE trial included community‐dwelling older adults without a prior history of CV disease (CVD). Prescribed opioid use was defined as opioid use at baseline and/or at the first annual visit (AV1). Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals (95% CI) for associations between opioid use and CVD events following AV1. Of the 17 701 participants included (mean age 75.2 years, 58.2% female), 813 took opioids either at baseline or at AV1. Over a median follow‐up period of 3.58 years (IQR 2.50–4.62), CVD events, most notably heart failure hospitalization, occurred in 7% (n = 57) amongst opioid users and 4% (n = 680) amongst non‐opioid users. After adjustment for multiple covariates, opiate use was associated with a 1.67‐fold (CI 1.26–2.23, P < 0.001) increase in the hazard ratio for CVD events. CONCLUSIONS: These findings identify opioid use as a non‐traditional risk factor for CVD events in community‐dwelling older adults.