Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study

Introduction: In 2019, Scotland reported the highest number of drug deaths amongst EU countries. Of the 1,264 drug deaths reported in 2019, 94% were related to polysedative use. Studies have proposed a relationship between opioid use and cardiovascular disease. Furthermore, the concomitant use of se...

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Autores principales:	Abdulmalik Zuhair Arab, Aldo Alberto Conti, Fleur Davey, Faisel Khan, Alexander Mario Baldacchino
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	CVD (cardiovascular disease) DD (drug death) PMR (post-mortem report) hs-CRP (high-sensitivity C-reactive protein) TNF–α (tumor necrosis factor alpha) IL-6 (interleukin 6) Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/a851ea49acd54409b1cbc6a84a94425b
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spelling	oai:doaj.org-article:a851ea49acd54409b1cbc6a84a94425b2021-11-05T07:44:52ZRelationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study1663-981210.3389/fphar.2021.725034https://doaj.org/article/a851ea49acd54409b1cbc6a84a94425b2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphar.2021.725034/fullhttps://doaj.org/toc/1663-9812Introduction: In 2019, Scotland reported the highest number of drug deaths amongst EU countries. Of the 1,264 drug deaths reported in 2019, 94% were related to polysedative use. Studies have proposed a relationship between opioid use and cardiovascular disease. Furthermore, the concomitant use of sedatives and opioids has been associated with lethal cardiopulmonary events. However, evidence is still limited for the relationship between polysedative use and cardiovascular diseases. Thus, the present study aimed to investigate the association between polysedative use and the underlying cardiovascular pathologies in drug deaths.Methods: This study consisted of a post-mortem investigation of 436 drug deaths. Data extracted from post-mortem reports included socio-demographic characteristics (e.g., gender, age), cardiovascular pathologies (e.g., atherosclerosis, atheroma, and inflammation), in addition to the presence of opioids (e.g. methadone, heroin) and other substances (e.g., alcohol, benzodiazepine) in the blood of the deceased. Stepwise multiple regression models were employed to identify which substances predicted cardiovascular pathologies.Results: The presence of opioids, benzodiazepines, and alcohol in the blood of the deceased predicted overall cardiovascular disease (CVD) severity [R2 = 0.33, F (5, 430) = 39.64, p < 0.0001; adjusted R2 = 0.32, f2 = 0.49]. Positive Beta coefficients may indicate an exacerbation of CVD (B = 0.48 95% CI = 0.25, 0.70) due to the presence of opioids in the blood of the deceased. Negative associations may instead indicate a relative protective effect of alcohol (B = −0.2, 95% CI = −0.41, −0.00) and benzodiazepines (B = −0.29, 95% CI = −0.48, −0.09) on CVD.Conclusion: These findings may inform national clinical guidelines on the need to monitor individuals who abuse opioids for presence of cardiovascular disease risk factors pathologies and provide timely interventions to reduce mortality in the population.Abdulmalik Zuhair ArabAldo Alberto ContiFleur DaveyFaisel KhanAlexander Mario BaldacchinoFrontiers Media S.A.articleCVD (cardiovascular disease)DD (drug death)PMR (post-mortem report)hs-CRP (high-sensitivity C-reactive protein)TNF–α (tumor necrosis factor alpha)IL-6 (interleukin 6)Therapeutics. PharmacologyRM1-950ENFrontiers in Pharmacology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	CVD (cardiovascular disease) DD (drug death) PMR (post-mortem report) hs-CRP (high-sensitivity C-reactive protein) TNF–α (tumor necrosis factor alpha) IL-6 (interleukin 6) Therapeutics. Pharmacology RM1-950
spellingShingle	CVD (cardiovascular disease) DD (drug death) PMR (post-mortem report) hs-CRP (high-sensitivity C-reactive protein) TNF–α (tumor necrosis factor alpha) IL-6 (interleukin 6) Therapeutics. Pharmacology RM1-950 Abdulmalik Zuhair Arab Aldo Alberto Conti Fleur Davey Faisel Khan Alexander Mario Baldacchino Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study
description	Introduction: In 2019, Scotland reported the highest number of drug deaths amongst EU countries. Of the 1,264 drug deaths reported in 2019, 94% were related to polysedative use. Studies have proposed a relationship between opioid use and cardiovascular disease. Furthermore, the concomitant use of sedatives and opioids has been associated with lethal cardiopulmonary events. However, evidence is still limited for the relationship between polysedative use and cardiovascular diseases. Thus, the present study aimed to investigate the association between polysedative use and the underlying cardiovascular pathologies in drug deaths.Methods: This study consisted of a post-mortem investigation of 436 drug deaths. Data extracted from post-mortem reports included socio-demographic characteristics (e.g., gender, age), cardiovascular pathologies (e.g., atherosclerosis, atheroma, and inflammation), in addition to the presence of opioids (e.g. methadone, heroin) and other substances (e.g., alcohol, benzodiazepine) in the blood of the deceased. Stepwise multiple regression models were employed to identify which substances predicted cardiovascular pathologies.Results: The presence of opioids, benzodiazepines, and alcohol in the blood of the deceased predicted overall cardiovascular disease (CVD) severity [R2 = 0.33, F (5, 430) = 39.64, p < 0.0001; adjusted R2 = 0.32, f2 = 0.49]. Positive Beta coefficients may indicate an exacerbation of CVD (B = 0.48 95% CI = 0.25, 0.70) due to the presence of opioids in the blood of the deceased. Negative associations may instead indicate a relative protective effect of alcohol (B = −0.2, 95% CI = −0.41, −0.00) and benzodiazepines (B = −0.29, 95% CI = −0.48, −0.09) on CVD.Conclusion: These findings may inform national clinical guidelines on the need to monitor individuals who abuse opioids for presence of cardiovascular disease risk factors pathologies and provide timely interventions to reduce mortality in the population.
format	article
author	Abdulmalik Zuhair Arab Aldo Alberto Conti Fleur Davey Faisel Khan Alexander Mario Baldacchino
author_facet	Abdulmalik Zuhair Arab Aldo Alberto Conti Fleur Davey Faisel Khan Alexander Mario Baldacchino
author_sort	Abdulmalik Zuhair Arab
title	Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study
title_short	Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study
title_full	Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study
title_fullStr	Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study
title_full_unstemmed	Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study
title_sort	relationship between cardiovascular disease pathology and fatal opioid and other sedative overdose: a post-mortem investigation and pilot study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/a851ea49acd54409b1cbc6a84a94425b
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Relationship Between Cardiovascular Disease Pathology and Fatal Opioid and Other Sedative Overdose: A Post-Mortem Investigation and Pilot Study

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