Opioid Users at Greater Risk for Atrial Fibrillation

Analysis of data from a previous study indicates that opioid use may increase the risk of heart attack by triggering atrial fibrillation (AF).

The observation that opioid agonists can reduce the incidence of AF in animals led researchers from Wake Forest and the University of Alabama to hypothesize that AF might explain the long-observed link between opioid use and heart attacks in humans.

They tested the theory with data on 24,632 patients from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.The average age of study participants was 64 ± 9.4 years. 54% of them were female, and 40% of them were black.

An in-home visit to each patient’s house provided information about prescription medication usage, while baseline electrocardiograms and patient interviews identified which patients had AF.

At the outset of the initial study, 1,887 patients (7.6%) used opioid-based analgesics and 2,086 of them (8.5%) suffered from AF. A total of 235 opioid users (12.5%) opioid users and 1,851 non-users (8.1%) had AF (p<.001).

Even after the study team adjusted for a huge number of factors — age, sex, race, region of residence, income, education, systolic blood pressure, high density lipoprotein cholesterol, total cholesterol, body mass index, smoking, diabetes, antihypertensive and lipid-lowering medications, aspirin, coronary heart disease, stroke, C-reactive protein, serum creatinine, albumin-to-creatinine ratio, peripheral arterial disease, and electrocardiographic left ventricular hypertrophy &mdash; opioid use was still associated a higher prevalence of AF (odds ratio, 1.35; 95% CI, 1.16,-1.57).

The researchers then split the total cohort and found that the relationship held true in subgroups stratified by age, sex, race, coronary heart disease, hypertension, and diabetes. They did not, however, conclude that their findings proved that opioid use could help trigger AF in all people.

“Further research is needed to confirm our findings and to explore the underlying mechanisms of this association,” they wrote in a research letter that appeared in JAMA Internal Medicine.

Researchers have long known of the association between opioid use and heart attack. The largest recent study to demonstrate the link looked at nearly 13,000 Medicare patients who took prescription pain medication and compared outcomes for those who used NSAIDs, COX-2 inhibitors and opioids. That paper, which appeared in the Archives of Internal Medicine, found that patients who used opioids were more than twice as likely to suffer a heart attack as those who used NSAIDs.

The link between AF and heart attack is also long established. Past research focused mostly on the tendency of people who suffer heart attacks to eventually develop AF. More recent work, like a study that appeared in Circulation, have found that AF increases the risk of heart attack, perhaps by as much as 70% overall.

Still, the authors of the new analysis believe they are the first to investigate a link between prescription opioid use and AF.

Concrete evidence of a strong link could mean that opioid use increases not only the risk of heart attack but also the risk of stroke and other negative outcomes associated with AF. It would also provide yet another reason for caution about the use prescription opioids, at least among patients with other characteristics that elevate their risk of developing AF.