Opium As a Risk Factor for Coronary Artery Disease in Young Iranians: Results from the Premature Coronary Artery Disease Milano-Iran (MIran) Study

Background: The spreading of opium addiction, especially in Asian countries, pose new health related concerns. In some areas its use is still believed to protect from cardiovascular disorders, such as coronary artery disease (CAD). However, whether opium use has an association with CAD is unclear. Methods: We set up a case-control analysis, i.e., the premature CAD Milano-Iran (MIran) study. We enrolled consecutive young patients who underwent a coronary angiography at the Tehran Heart Center, between 2009 and 2012. Incident cases with CAD were contrasted with controls for habitual opium use. Relative risks were calculated in terms of odds ratios (ORs) by logistic regression models adjusted for age, sex, cigarette smoking, body mass index, hypertension, hyperlipidaemia, and diabetes. We performed interaction analyses between opium use and hypertension, hyperlipidaemia and diabetes. Findings: 1011 patients with CAD (mean age 43.6 years) and 2002 controls (mean age 54.3 years) were included in the study. Habitual opium users had a 3.8-fold increased risk of CAD (95%CI 2.4-6.2) compared with non-users. The association was strongest for men, with a fully adjusted OR of 5.5 (95%CI 3.0-9.9). No interaction was observed for the combination of opium addiction and hypertension, or diabetes. On the contrary, an excess in risk was found in opium users with hyperlipidaemia (OR 16.8, 95%CI 8.9-31.7, expected OR 12.2), suggesting supra-additive interaction. Interpretation: Despite common beliefs, our study showed that opium addiction is associated with an increased risk of CAD, even when other cardiovascular risk factors are taken into account. Funding Statement: the Tehran Heart Center and the Universita degli Studi di Milano. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The study was approved by the Ethical committee Board of Tehran Heart Center, and all patients and controls signed informed consent before inclusion in the study.