Investigating the Impact of Opioid Use on Cardiovascular Diseases in Scotland

  • Abdulmalik Zuhair Omar Arab

Student thesis: Doctoral ThesisDoctor of Philosophy


Opioid use is a growing concern that contributes to high morbidities and mortalities, creating huge challenges to health care systems and economic burden around the world. Alarmingly, Scotland has lately reached the highest prevalence of drug overdose related mortalities in comparison to EU and US, approaching 13 folds greater rate than the average rate in EU. Opioids contribute to 80-90 % of these mortalities. Several studies have proposed that cardiovascular diseases (CVD) are among the leading causes of deaths related to the chronic use of opioids. A significant amount of the literature has been published on the impact of acute opioids use on cardiovascular function. Notwithstanding, there is limited data suggesting that chronic opioids use may elevate the risk of CVD adverse effects. Therefore, this study aims to investigate the association between opioid presence, chronic use, and/or misuse on CVD, CVD risk factors, and CVD related mortalities in Scotland. To successfully achieve the aims of this project, three work-packages were employed including a systematic review, a pilot study exploring post-mortem reports (PMRs) of drug-related deaths (DDs), and a population-based dataset analysis. The systematic review identified, assessed, and summarised the outcomes of all relevant studies regarding the link between chronic opioid use and CVD for the purpose of addressing the gaps in the literature. The pilot study examined data from 436 PMRs for an association between opioid and other sedatives used and underlying CVD pathologies in DDs. The dataset analysis extracted relevant information for chronic opioid users within NHS Tayside and Fife including socio-demographics characteristics, laboratory investigations, drugs prescription data, hospitalisations, as well as all-cause mortality data. The dataset investigated the opioid prescriptions in relation to CVD admissions and mortalities in 12130 chronic opioid users in comparison to a matched control group. The systematic review outcomes supported a significant correlation between chronic opioid consumption and the risk of developing various cardiovascular dysfunctions and worsening CVD outcomes. The pilot PMRs study showed that the presence of opioids, benzodiazepines, and alcohol in the blood of the deceased significantly predicted total CVD severity [R2= 0.33, p < 0.0001; adjusted R2= 0.32, f2= 0.49]. The dataset analysis represented a significant association between chronic opioid prescription and elevated risk of CVD admissions (OR = 3.55, 95% CI 2.54 – 4.97, p < 0.001) as well as CVD death (OR = 1.88, 95% CI 1.11 – 3.21, p = 0.019). In conclusion, this study represents a significant correlation between chronic opioid use and increased risk of CVD pathologies, CVD admissions, as well as CVD related mortalities. These findings hold potential contribution in developing future evidence-based clinical guidelines to help CVD monitoring in clinical areas dealing with licit and illicit opioid population. Nonetheless, further studies conclusively elucidating the underlying mechanisms through which opioids affect CVD are crucial in curtailing the CVD burden.
Date of Award2022
Original languageEnglish
SponsorsMinistry of Education, Saudi Arabia
SupervisorFaisel Khan (Supervisor) & Alex Baldacchino (Supervisor)

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