Opium addiction increases interleukin 1 receptor antagonist (IL-1Ra) in the coronary artery disease patients

Cardiovascular health in kratom users; a narrative review

BACKGROUND

Kratom, also known as Mitragyna speciosa, is a plant that originates in Southeast Asia and possesses unique pharmacological characteristics. It is commonly consumed in the form of tea made by boiling the leaves or using the leaves to create the powder. According to its pain-relieving effects, the prevalence of kratom use around the world has increased, which has various implications for healthcare providers. Mitragynine is a well-known active compound in kratom.

OBJECTIVE

This review aims to provide a comprehensive perspective on the cardiovascular effects of mitragynine and its potential cardiotoxicity through the literature.

METHOD

Authors searched PubMed, Scopus, and Google Scholar databases using appropriate search strategies for each database. After the screening, all relevant studies were included.

RESULTS

Although kratom may have the potential for therapeutic benefits, it has been associated with multi-organ damage and cardiac toxicity in some cases. According to the available data, tachycardia and hypertension are the most common adverse effects. Other possible cardiovascular effects include atherosclerosis, ventricular arrhythmia, cardiomyopathy, dose-dependent prolonged QTc interval, myocarditis, cardiomegaly, and cardiopulmonary arrest.

CONCLUSION

While prior research has indicated the possible negative effects of mitragynine overdose on the cardiovascular system, there are no definitive conclusions, and additional investigations are needed.

Impacts of opium addiction on patterns of angiographic findings in patients with acute coronary syndrome

Opium is one of the most abused substances in the Middle East. The effects of opium use on coronary artery disease (CAD) are a matter of debate. This study aimed to assess the association between opium use and angiographic findings as well as the complexity of CAD in patients with acute coronary syndrome (ACS) diagnosis. In this case–control study, all patients admitted for coronary angiography from 2019 to 2020 were evaluated. After applying the eligibility criteria, they were categorized into two groups opium and non-opium based on their history of opium use. Both groups were matched regarding the demographic features. The prevalence, location, and severity of obstruction of the vessels were compared between the non-opium and opium groups. The SYNTAX score was also calculated and compared between the two groups. The scores ≤ 22 are considered low risk and the higher scores are a non-low risk. P value < 0.05 is considered significant. A total of 170 patients with a mean age of 61.59 ± 9.07 years were finally enrolled in our study. Regarding the severity of vascular involvement, there was a significant difference between the non-opium and opium groups in LAD (P = 0.025), and PLV (P = 0.018) vessels. From the location points of view of obstructive coronary artery involved segments, only in the PDA (P = 0.006), and LCX (P = 0.004) vessels, a significant difference was observed. Moreover, 47.1% of opium and 30.6% of non-opium use group were in the non-low risk SYNTAX score classification which is a statistically significant difference between these two groups (P value = 0.048). Opium, as an independent risk factor for cardiovascular diseases, can have specific effects on angiographic findings in patients with acute coronary syndrome. Likewise, the complexity of CAD in opium users who undergo percutaneous coronary intervention is significantly higher.

Effect of persistent opium consumption after surgery on the long-term outcomes of surgical revascularisation

Background

A wrong traditional belief persists among people that opium consumption beneficially affects cardiovascular disease and its risk factors. However, no evidence exists regarding the effect of opium consumption or cessation on the long-term risk of major adverse cardio-cerebrovascular events after coronary artery bypass grafting. We therefore aimed to evaluate the effect of persistent opium consumption after surgery on the long-term outcomes of coronary artery bypass grafting.

Methods

The study population consisted of 28,691 patients (20,924 men, mean age 60.9 years), who underwent coronary artery bypass grafting between 2007 and 2016 at our centre. The patients were stratified into three groups according to the status of opium consumption: never opium consumers (n = 23,619), persistent postoperative opium consumers (n = 3636) and enduring postoperative opium withdrawal (n = 1436). Study endpoints were 5-year mortality and 5-year major adverse cardio-cerebrovascular events, comprising all-cause mortality, acute coronary syndrome, cerebrovascular accident and revascularisation.

Results

After surgery, 3636 patients continued opium consumption, while 1436 patients persistently avoided opium use. The multivariable survival analysis demonstrated that persistent post-coronary artery bypass grafting opium consumption increased 5-year mortality and 5-year major adverse cardio-cerebrovascular events by 28% (hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.06–1.54; P = 0.009) and 25% (HR 1.25, 95% CI 1.13–1.40; P &lt; 0.0001), respectively. It also increased the 5-year risk of acute coronary syndrome by 34% (sub-distribution HR 1.34, 95% CI 1.16–1.55; P &lt; 0.0001).

Conclusions

The present data suggest that persistent post-coronary artery bypass grafting opium consumption may significantly increase mortality, major adverse cardio-cerebrovascular events and acute coronary syndrome in the long term. Future studies are needed to confirm our findings.

Opium and cardiovascular health: A devil or an angel?

Opioids have the highest rate of illicit drug consumption after cannabis worldwide. Opium, after tobacco, is still the most commonly abused substance in the Middle East. In addition to the ease of availability, one reason for the high consumption of opium in Asian countries might be a traditional belief among Eastern people and even medical staff that opium may have ameliorating effects on cardiovascular diseases (CVDs) as well as diabetes mellitus, hypertension, and dyslipidemia. Over the last decade, many studies have been performed on humans and animals to evaluate the interplay between opium consumption and stable coronary artery disease, acute coronary syndromes, and atherosclerosis. In this review, we conclude that opium consumption should be considered a risk factor for CVDs. Healthy individuals, as well as cardiac and diabetic patients, should be informed and educated about the hazardous effects of opium consumption on cardiovascular and other chronic diseases.

Immune-Inflammation in Atherosclerosis: A New Twist in an Old Tale

Background and Objective:

Atherosclerosis, a chronic and progressive inflammatory disease, is triggered by the activation of endothelial cells followed by infiltration of innate and adaptive immune cells including monocytes and T cells in arterial walls. Major populations of T cells found in human atherosclerotic lesions are antigen-specific activated CD4+ effectors and/or memory T cells from Th1, Th17, Th2 and Treg subsets. In this review, we will discuss the significance of T cell orchestrated immune inflammation in the development and progression of atherosclerosis.

Discussion:

Pathogen/oxidative stress/lipid induced primary endothelial wound cannot develop to a full-blown atherosclerotic lesion in the absence of chronically induced inflammation. While the primary inflammatory response might be viewed as a lone innate response, the persistence of such a profound response over time must be (and is) associated with diverse local and systemic T cell responses. The interplay between T cells and innate cells contributes to a phenomenon called immuneinflammation and has an impact on the progression and outcome of the lesion. In recent years immuneinflammation, an old term, has had a comeback in connecting the puzzle pieces of chronic inflammatory diseases.

Conclusion:

Taking one-step back and looking from afar at the players of immune-inflammation may help us provide a broader perspective of these complicated interactions. This may lead to the identification of new drug targets and the development of new therapies as well as preventative measures.

The effects of opium on the cardiovascular system: a review of side effects, uses, and potential mechanisms

BACKGROUND

In Iran, as in many other Asian and Middle Eastern countries, some believe that opium has beneficial effects on cardiovascular system. Dependent patients suppose that opium has positive effects on cardiovascular function and can prevent or improve cardiovascular diseases; however, only few comprehensive studies evaluating such effects have been performed.

OBJECTIVES

In this study, we sought to clarify the effect of opium on cardiovascular problems by incorporating the previous findings and the current information on the issue and to explain the possible mechanisms of this effect.

METHODS

The available human studies published up to October 30, 2019, were searched in different databases. Case-control, cohort, and cross-sectional studies were retrieved. Papers published in English or those with an English abstract were included. The risk of bias for each included study was assessed based on the Newcastle-Ottawa Scale (NOS). We then categorized the effects of opium on cardiovascular problems along with its probable underlying mechanisms of action.

RESULTS

In this study, most of the published articles suggested the adverse effects of opium on the cardiovascular system, including atherosclerosis, myocardial infarction, arrhythmia, low ejection fraction, and cardiovascular mortality; however, some articles reported the beneficial or impartial effects of opium on the cardiovascular system. In this article, we have categorized all the effects of opium on cardiovascular system; also, the proposed mechanisms of action of opium in each of the above-mentioned disorders are summarized.

CONCLUSION

Although the available evidences were incoherent, it was mostly suggested that opium use does not protect against or improve cardiovascular problems.

Opium use and cardiovascular diseases: a systematic review and meta-analysis

The effects of opium on cardiovascular diseases (CVDs) have been extensively studied. However, there are few studies that summarize this research comprehensively; thus, this systematic review and meta-analysis is a collection of the newest information combined with previous findings to furthermore illuminate the effects of opium on CVDs. In this systematic review, all observational studies were systematically searched using the main international databases such as PubMed/Medline, Web of Sciences, and Scopus until October 2018. After the quality assessment of the articles, the fixed or random model meta-analysis was used to pool the results. I-square test was used to assess the heterogeneity of the studies. Overall, 41 studies were identified. Based on the random model, the pooled odds ratio (OR) (95% confidence interval (CI)) of opium use and coronary artery diseases (CAD) was estimated at 2.75 (95% CI = 2.04-3.75; I²=47%). The pooled OR of opium use and CVD in-hospital mortality was not statistically significant (OR: 1.44, 95% CI = 0.88-2.36, I²  = 51%). In the stratified analysis, in the patients who had undergone heart surgery, the average of ejection fraction (EF) in the opium users was significantly lower than those not using opium (mean differences: -3.06, CI 95% = -4.40 to -1.71, I² = 60%) but in the patients with acute myocardial infarction undergoing angiography, the average EF was not significantly different in the opium users compared to non-users (mean difference: 0.30, CI: -0. 55 to 1.15). The results of this meta-analysis revealed that opium might be a risk factor for CAD and EF but not in-hospital mortality.

Increasing the Risk of Stroke by Opium Addiction

INTRODUCTION

Stroke is among the leading causes of mortality and morbidity in the world. Besides the identified risk factor, Ischemic stroke evidence show drug use develops or exacerbates the atherosclerotic process. The current study aimed at comparing cerebrovascular ultrasounds' changes in addicted and nonaddicted people who developed ischemic stroke.

METHODS

In the current cross-sectional study, a total of 133 patients with ischemic stroke who were admitted to Vali-Asr hospital from June 2016 to April 2017 were enrolled. For obtaining the quantitative data, t test or Mann-Whitney test was employed to compare the addict or no-addict groups, as well as, categorical data testing was performed using chi-square test. Also, the multiple logistic regression was used for identifying the factors and the significance level was set at 5%.

RESULTS

The current study was performed on 133 patients, among them 41 patients (30.8%) were opium addicted, and 92 patients (69.2%) were nonaddict. The mean [IQR] number of atherosclerotic plaques were significantly higher in opium addicted group in comparison with the nonaddicted group (3.0 [1.0-4.0] versus 1.5 [0.0-3.0], P = .008). The possibility of increasing the number of plaques in addicted patients was 1.42 times higher than the nonaddicted patients (odds ratio (95% confidence interval): 1.42 (1.11-1.81), P = .005).

CONCLUSION

The findings demonstrated a significant difference in the vessel stenosis pattern between the addict and nonaddict ischemic stroke groups. To investigate the possible effects of opium use and its associated parameters, ie, dosage, duration of use, and the way of opium use on ischemic stroke, further studies are required.

Inflammation: A Novel Therapeutic Target/Direction in Atherosclerosis

Over the past two decades, the viewpoint of atherosclerosis has been replaced gradually by a lipid-driven, chronic, low-grade inflammatory disease of the arterial wall. Current treatment of atherosclerosis is focused on limiting its risk factors, such as hyperlipidemia or hypertension. However, treatment targeting the inflammatory nature of atherosclerosis is still very limited and deserves further attention to fight atherosclerosis successfully. Here, we review the current development of inflammation and atherosclerosis to discuss novel insights and potential targets in atherosclerosis, and to address drug discovery based on anti-inflammatory strategy in atherosclerotic disease.

The Effects of Opium Addiction on the Immune System Function in Patients with Fungal Infection

BACKGROUND

The use of narcotics such as opium exposes addicts as susceptible targets of different diseases so that they might easily be exposed to different diseases such as fungal infections. The present study aimed to investigate the effects of addiction to opium and fungal infection on plasma levels of certain cytokines including interleukin-4 (IL-4), IL-6, IL-17, Interferon gamma (IFN-γ) and transforming growth factor-β (TGF-β).

METHODS

Present study included 72 individuals who were divided into 4 groups: 1) opium-addicted with fungal infection; 2) opium-addicted without fungal infection; 3) non-opium-addicted with fungal infection; and 4) normal individuals (non-opium-addicted and non-fungal infection). The fungal samples, after being detected and confirmed by a physician, were prepared based on clinical symptoms and then analyzed by direct smear and culture method. The measurement of the plasma level of cytokines was done by enzyme-linked immunosorbent assay (ELISA) method.

FINDINGS

The comparison of the mean of the plasma level of cytokines showed that addiction to opium and fungal infection had significant effect on the plasma levels of IL-17, IFN-γ, TGF-β cytokines in all studied groups. The interaction of addiction to opium and fungal infection was only significant in the case of plasma level of IL-6.

CONCLUSION

Addiction to opium and fungal infection, either separately or simultaneously, poses significant effect on the immune system and causes disorders in the cytokine network and the immune system and also provides a suitable environment for fungal infection.

Opium dependency and in-hospital outcome of acute myocardial infarction

BACKGROUND

Impact of substance abuse on outcome of hospitalized patients with acute myocardial infarction (MI) is a frequent question. Available studies show disagreements over its impact, thus we performed this study to find a clear answer.

METHODS

In a cross sectional study, 304 patients (include 152 consecutive opium dependents and equal number of independents) with acute MI admitted to coronary care units (CCU) in Bou-Ali Sina Hospital of Qazvin University of Medical Science were enrolled. Data on demographics (e.g. age, sex and education), identified MI risk factor (smoking and diabetes), clinical findings (e.g. Killip class and in-hospital mortality), ECG findings (e.g. localization of infarction and arrhythmia), echocardiographic examinations (e.g. ejection fraction and regional wall motion abnormality) and laboratory findings (lipid profile, glycemic situation) were gathered.

RESULTS

The mean age was 63.01±12 years for opium users and 64.3± 10 for non-users. Educational level was higher in patients who used opium. No significant differences were found between opium users and non-users in rate of hypertension, diabetes mellitus, hyperlipidemia, and cigarette smoking. The mean duration of experienced chest pain in hospital stay was significantly higher in non-opium users compared to opium users (1.78± 0.63 vs.1.52±0.54) (p< 0.001). Higher Killip class and arrhythmia have been identified as the most important independent predictors of early in-hospital mortality (in both groups).

CONCLUSION

The higher Killip class and age identified as the most important independent predictors of early in-hospital mortality and addiction do not act as a major risk or protecting factor in this context. Nevertheless, we believe that a more comprehensive study with follow up of patients should be carried out for evaluation of opium addicted patients, their outcome after MI, and a better decision making for their treatment.

Survey of the effect of opioid abuse on the extent of coronary artery diseases

Introduction:

Cardiovascular disease is the most common cause of death in our country. Recently, it has been found that the use of opium like other risk factors can be an independent risk factor for coronary artery disease. Therefore, this study examines the impact of opioid abuse on the extent of coronary artery diseases.

Methods:

This study included 1170 individuals, who underwent coronary angiography in Seyed-ol-shohada and Taleghani hospitals, Urmia in 2012, were enrolled. The demographic data included age, sex, medical history, including history of diabetes, hypertension, heart disease and a history of opioid abuse and duration of smoking were extracted and entered in a questionnaire.

Results:

The results of this study showed that 121 had taken opium and 1049 patients had not taken the drug. The results of this study showed that coronary artery disease (CAD) in patients with drug use (88.5%) was significantly higher than the group without drug use (72.2 %) (P=0.000). However, significant differences are not exist between the two groups regarding the number of affected coronary arteries (P=0.679).

Conclusion:

although risk factors of CAD such as HTN and DM is higher in patients without opium addiction than in addicted patients, but CAD was more created in patients using drugs and this suggests drugs as an important risk factor for coronary artery disease.

Effect of intravenous patient controlled ketamine analgesiaon postoperative pain in opium abusers

Background:

Acutepostoperative pain is among the worst experience that patient scan undergo, and many analgesics have been used to suppress it; especially in chronic opium abusers. Ketamine is an N-methyl-D-aspartate antagonist analgesic, having both anesthetic and analgesic properties, which are not affected to the same extent in chronic opium abusers.

Objectives:

In this study, we assessed the analgesic effects of ketamine added to morphine as a patient-controlled analgesia method for acute pain management, compared with a placebo, inchronic maleopium abusers.

Patients and Methods:

After institutional review board approval for ethical considerations, a randomized double-blinded placebo controlled clinical trial was conducted. A total of 140 male patients aged 18-65 years, undergoing orthopedic surgery, were entered into the study after matching inclusion and exclusion criteria. All patients received the same anesthesia method; while the first group received ketamine (1mg/mL) and morphine (0.5 mg/mL) as a patient-controlled analgesia (70 patients), the second group received morphine (0.5 mg/mL) plus normal saline (70 patients). P value less than 0.05 was considered statistically significant.

Results:

The ketamine and morphine group of patients experienced less postoperative pain and required less postoperative rescue analgesia. However, the unwanted postoperative side effects were nearly the same; although increased levels of postoperative nausea and vomiting were observed in the ketamine and morphine group

Conclusions:

This study demonstrated improved analgesic effects after using intravenous patient controlled analgesia with ketamine on postoperative pain in opium abusers.

Opium consumption and mid-term outcome of percutaneous coronary intervention in men

BACKGROUND

Controversy persists over the potential benefits/harms of opium consumption in coronary heart disease. This study investigated the association between 12 months' major adverse cardiac events (MACE) and pre-procedural opium consumption among patients undergoing percutaneous coronary intervention (PCI).

METHODS

Retrospectively, 1545 consecutive men who underwent PCI between 21(st) June 2009 and 20th June 2010 at Tehran Heart Center and were registered in the PCI Databank were entered into this cohort study. The occurrence of MACE, defined as cardiac death, non-fatal myocardial infarction, and need for target vessel revascularization (TVR) or target lesion revascularization (TLR), was compared between two groups of opium consumers and non-consumers in 350 (22.7%) patients.

RESULTS

Sixty-four (0.86%) patients expired within 12 months. After adjustment for potential confounders, analysis revealed that opium consumption had no significant relationship with 12 months' MACE [11(3.1%) vs. 53(4.4%); p value = 0.286, among opium users vs. non users, respectively].Furthermore, the different components of MACE, including target vessel revascularization, target lesion revascularization, coronary artery bypass graft, and non-fatal myocardial infarction, were not significantly related to opium use.

CONCLUSION

Pre-procedural opium usage in patients undergoing PCI was not associated with 12 months' MACE.

Effects of opium consumption on cardiometabolic diseases

Opium is the second-most-commonly abused substance (after tobacco) in developing countries of the Middle East region, and in many Asian nations. One of the reasons for the high prevalence of opium abuse in these countries is a traditional belief among Eastern people, even including some medical staff, that opium might have beneficial effects on cardiovascular health and in the control of diabetes mellitus, hypertension, and dyslipidaemia. In this Perspectives article, we summarize the current understanding of the pharmacotoxicology of opium and its specific effects on glycaemic control, blood pressure, lipid profile, and atherosclerosis. On the basis of the available evidence, we believe not only that opium has no ameliorating effect on cardiovascular diseases, but also that the use of this drug might have adverse effects on these conditions. Therefore, people should be educated about the hazardous effects of opium consumption on cardiometabolic diseases.