Elevation of Central Arterial Stiffness and Vascular Ageing in Opiate Withdrawal: Cross-sectional and Longitudinal Studi
- PDF / 525,728 Bytes
- 13 Pages / 595.276 x 790.866 pts Page_size
- 60 Downloads / 201 Views
Elevation of Central Arterial Stiffness and Vascular Ageing in Opiate Withdrawal: Cross-sectional and Longitudinal Studies Albert Stuart Reece • Gary Kenneth Hulse
Published online: 19 September 2012 Ó Springer Science+Business Media, LLC 2012
Abstract The central cardiovascular impacts of clinical opiate withdrawal have not been explored in detail. Pulse Wave Analysis (SphygmoCor) was conducted in healthy controls and opiate-dependent populations. A total of 1,294 patients (69.2 % male) were studied in quintuplicate on 2,089 occasions. Four groups were studied: control (N = 576), buprenorphine stabilized (N = 592), withdrawal (N = 112) and severe withdrawal (N = 14). Control patients were younger than the other groups (29.96 ± 0.45 years v. 32.53 ± 0.74–39.28 ± 3.86) but had similar sex ratios. Multiple regression was used to correct for the effects of age, and significant exacerbations were found in withdrawal in the vascular age (RA), augmentation index, subendocardial perfusion ratio (SEVR \100; R.R. 2.07 95 % C.I. 1.17–3.68, P = 0.02) and central systolic pressure both as factors themselves and in interactions with age (all P \ 0.01). The elevation of modelled RA at 60 years was from 69.66 in controls to 97.54 in withdrawal (40.02 %). The effects on RA were found in both sexes and confirmed on longitudinal analysis. The elevation of RA in withdrawal was most marked after 40 years of age (P = 0.027). These results show increased vascular stiffness and cardiovascular age but reduced subendocardial perfusion in opiate withdrawal. Given the daily recurrent nature of withdrawal, these effects are likely cumulative.
Electronic supplementary material The online version of this article (doi:10.1007/s12012-012-9186-7) contains supplementary material, which is available to authorized users. A. S. Reece (&) G. K. Hulse School of Psychiatry and Clinical Neurosciences, University of Western Australia, 39 Gladstone Rd., Highgate Hill, Brisbane, QLD, Australia e-mail: [email protected]
Keywords Arterial stiffness Heroin Opiates Vascular ageing
Introduction Opiate dependence is typically a long-term clinical problem characterized by multiple and recurrent period of relapse and retreatment over several years, which may arise via multiple pathways including use of illicit or misuse of prescribed opiates or iatrogenically through, for example, the management of chronic pain [1–4]. Data from one large US national survey show that over 12,000,000 Americans used pain killers in the preceding month [5, 6]; there were 235 million opiate prescriptions written in the USA in 2004, and 7.3 % of respondents report a lifetime history of licit or illicit drug addiction [7]. Most research investigating the effects of chronic opiate use or opiate dependence on the human body has been primarily focused on the brain and neuraxis. However, internationally several papers have documented an increased rate of coronary artery disease in opiate-dependent populations [8, 9], including one from very large databases which reported a relat
Data Loading...
