The Relationship between Opium Addiction and the Severity of Atherosclerosis, Lipid Profile, Inflammatory Cytokines, and Renal Function in Non-diabetic Patients Subjected to Angiography

Document Type : Original Article


1 Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Clinical Research Development Unit, Shafa Hospital, kerman University of Medical Sciences, Kerman, Iran

3 Department of Cardiology, School of Medicine, Bam University of Medical Sciences, Bam, Iran

4 Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran


Background: Despite traditional beliefs about the beneficial effects of opium use, current evidence suggests an adverse effect of this substance on cardiovascular disease (CVD) risk factors. The present study aimed to investigate the association between opium-addiction status and lipid profile, the severity of atherosclerosis (measured by Gensini score), inflammatory cytokines, and renal function among non-diabetic patients subjected to angiography.
Methods: This cross-sectional study was conducted on 95 post-angiography patients. Routine tests including lipid profile, blood urea, creatinine, and hematocrit were collected at the time of admission. Also, serum levels of IL-6 and IL-8 were measured using ELISA. Independent sample t-test, Mann-Whitney U test, and chi-square were used to compare variables according to opium addiction. Multivariate regression was conducted to adjust the effect of potential confounding variables.
Results: Opium-addict subjects had a higher IL-6 (P=0.049) level and PLT number (P=0.005). In contrast, there was a lower level of TG (P=0.015) and GFR (P=0.039) in the opium-addict group. There was no association between opium addiction and other variables (P>0.05).
Conclusion: Although no significant association was observed between addiction and atherosclerosis and even there was a lower level of TG in addict subjects, there was a direct association between the serum IL-6 levels (an important inflammatory cytokine with adverse effects on coronary artery disease) and opium addiction. It has been revealed that confounding variables affect the relationship between opium use and CVD outcomes. Therefore, well-designed prospective studies controlling a vast range of general variables seem to be necessary.


  1. Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, et al. European society of cardiology: cardiovascular disease statistics 2019. Eur Heart J. 2020; 41(1):12-85. doi: 10.1093/eurheartj/ehz859.
  2. Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc Dis. 2017; 6:2048004016687211. doi: 1177/2048004016687211.
  3. Ashtary-Larky D, Kashkooli S, Bagheri R, Lamuchi-Deli N, Alipour M, Mombaini D, et al. The effect of exercise training on serum concentrations of chemerin in patients with metabolic diseases: A systematic review and meta-analysis. Arch Physiol Biochem. 2021: 1-10. doi: 10.1080/13813455.2021.1892149. 
  4. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012; 33(13):1635-701. doi: 10.1093/eurheartj/ehs092.
  5. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: The sixth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European association for cardiovascular prevention & rehabilitation (EACPR). Eur Heart J. 2016; 37(29):2315-81. doi: 10.1093/eurheartj/ehw106. 
  6. Roayaei P, Aminorroaya A, Vasheghani-Farahani A, Oraii A, Sadeghian S, Poorhosseini H, et al. Opium and cardiovascular health: A devil or an angel? Indian Heart J. 2020; 72(6):482-90. doi: 10.1016/j.ihj.2020.10.003.
  7. Amin-Esmaeili M, Rahimi-Movaghar A, Sharifi V, Hajebi A, Radgoodarzi R, Mojtabai R, et al. Epidemiology of illicit drug use disorders in Iran: Prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey. 2016; 111(10):1836-47. doi: 10.1111/add.13453.
  8. Masoudkabir F, Sarrafzadegan N, Eisenberg MJ. Effects of opium consumption on cardiometabolic diseases. Nat Rev Cardiol. 2013; 10(12):733-40. doi: 1038/nrcardio.2013.159.
  9. Khademi H, Malekzadeh R, Pourshams A, Jafari E, Salahi R, Semnani S, et al. Opium use and mortality in golestan cohort study: Prospective cohort study of 50 000 adults in Iran. BMJ. 2012; 344:e2502. doi: 10.1136/bmj.e2502.
  10. Ebdali RT, Tabaee SS, Tabaei S. Cardiovascular complications and related risk factors underlying opium consumption. J Cell Physiol. 2019; 234(6):8487-95. doi: 10.1002/jcp.27780.
  11. Asgary S, Sarrafzadegan N, Naderi GA, Rozbehani R. Effect of opium addiction on new and traditional cardiovascular risk factors: Do duration of addiction and route of administration matter? Lipids Health Dis. 2008; 7:42. doi: 10.1186/1476-511X-7-42.
  12. Ghazavi A, Solhi H, Moazzeni SM, Rafiei M, Mosayebi G. Cytokine profiles in long-term smokers of opium (Taryak). J Addict Med. 2013; 7(3):200-3. doi: 10.1097/ADM.0b013e31828baede.
  13. Lashkarizadeh MR, Garshasbi M, Shabani M, Dabiri S, Hadavi H, Manafi-Anari H. Impact of opium addiction on levels of pro- and anti-inflammatory cytokines after surgery. Addict Health. 2016; 8(1):9-15. PMID: 27274788.
  14. Asadikaram G, Igder S, Jamali Z, Shahrokhi N, Najafipour H, Shokoohi M, et al. Effects of different concentrations of opium on the secretion of interleukin-6, interferon-γ and transforming growth factor beta cytokines from jurkat cells. Addict Health. 2015; 7(1-2):47-53. PMID: 26322210.
  15. Saadat H, Ziai SA, Ghanemnia M, Namazi MH, Safi M, Vakili H, et al. Opium addiction increases interleukin 1 receptor antagonist (IL-1Ra) in the coronary artery disease patients. PLoS One. 2012; 7(9):e44939-e. doi: 10.1371/journal.pone.0044939.
  16. Moezi Bady SA, Soltani M, Kazemi T, Khosravi Bizhaem S, Hanafi Bojd N, Partovi N, et al. Surveying the effect of opioid abuse on the extent of coronary artery diseases in diabetic patients. J Addict. 2020; 2020:8619805. doi: 10.1155/2020/8619805.
  17. Segal DL. Diagnostic and statistical manual of mental disorders (DSM-IV-TR). The Corsini Encyclopedia of Psychology. 2010; 1-3.
  18. Hojs R, Bevc S, Ekart R, Gorenjak M, Puklavec L. Kidney function estimating equations in patients with chronic kidney disease. Int J Clin Pract. 2011; 65(4):458-64. doi: 10.1111/j.1742-1241.2010.02597.x.
  19. Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: A prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008; 52(25):2135-44. doi: 10.1016/j.jacc.2008.08.058.
  20. Ziaaddini H, Ziaaddini MR. The household survey of drug abuse in Kerman, Iran. Journal of Applied Sciences. 2005; 5(2):380-2. doi: 3923/jas.2005.380.382.
  21. Hosseini SK, Masoudkabir F, Vasheghani-Farahani A, Alipour-Parsa S, Sheikh Fathollahi M, Rahimi-Foroushani A, et al. Opium consumption and coronary atherosclerosis in diabetic patients: A propensity score-matched study. Planta Med. 2011; 77(17):1870-5. doi: 10.1055/s-0031-1280017. 
  22. Sadeghian S, Graili P, Salarifar M, Karimi AA, Darvish S, Abbasi SH. Opium consumption in men and diabetes mellitus in women are the most important risk factors of premature coronary artery disease in Iran. Int J Cardiol. 2010; 141(1):116-8. doi: 10.1016/j.ijcard.2008.11.063.
  23. Mousavi M, Kalhor S, Alizadeh M, Movahed MR. Opium addiction and correlation with early and six-month outcomes of presenting with st elevation myocardial infarction treated initially with thrombolytic therapy. Am J Cardiovasc Dis. 2021; 11(1):115-23. PMID: 33815927.
  24. Shirani S, Shakiba M, Soleymanzadeh M, Esfandbod M. Can opium abuse be a risk factor for carotid stenosis in patients who are candidates for coronary artery bypass grafting? 2010; 17(3):254-8. PMID: 20535715.
  25. Mirzaiepour F, Dadras M, Forood A, Najafipour H, Shokoohi M. The effect of opium addiction on arrhythmia following acute myocardial infarction. Acta Med Iran. 2012; 50(10):670-5. PMID: 23275281.
  26. Javadi HR, Allami A, Mohammadi N, Alauddin R. Opium dependency and in-hospital outcome of acute myocardial infarction. Med J Islam Repub Iran. 2014; 28:122. PMID: 25679001.
  27. Masoomi M, Ramezani MA, Karimzadeh H. The relationship of opium addiction with coronary artery disease. Int J Prev Med. 2010; 1(3):182-6. PMID: 21566789.
  28. Pepine CJ, Ferdinand KC, Shaw LJ, Light-McGroary KA, Shah RU, Gulati M, et al. Emergence of nonobstructive coronary artery disease: A woman's problem and need for change in definition on angiography. J Am Coll Cardiol. 2015; 66(17):1918-33. doi: 10.1016/j.jacc.2015.08.876.
  29. Esmaeili Nadimi A, Pour Amiri F, Sheikh Fathollahi M, Hassanshahi G, Ahmadi Z, Sayadi AR. Opium addiction as an independent risk factor for coronary microvascular dysfunction: A case-control study of 250 consecutive patients with slow-flow angina. Int J Cardiol. 2016; 219:301-7. doi: 10.1016/j.ijcard.2016.06.034.
  30. Jalali Z, Khademalhosseini M, Soltani N, Esmaeili Nadimi A. Smoking, alcohol and opioids effect on coronary microcirculation: An update overview. BMC Cardiovasc Disord. 2021; 21(1):185. doi: 10.1186/s12872-021-01990-y.
  31. Karajibani M, Montazerifar F, Khazaei Feizabad A. Study of oxidants and antioxidants in addicts. Int J High Risk Behav Addict. 2017; 6(2):e3505. doi: 10.5812/ijhrba.35057.
  32. Shojaeepour S, Fazeli M, Oghabian Z, Pourgholi L, Mandegary A. Oxidative stress in opium users after using lead-adulterated opium: The role of genetic polymorphism. Food Chem Toxicol. 2018; 120:571-7. doi: 10.1016/j.fct.2018.07.061.
  33. Jia L, Yuan J-Q, Zhu L, Zhang Y. High high-sensitivity C-reactive protein/BMI ratio predicts future adverse outcomes in patients with acute coronary syndrome. Coron Artery Dis. 2019; 30(6):448-54. doi: 10.1097/MCA.0000000000000719..
  34. Su D, Li Z, Li X, Chen Y, Zhang Y, Ding D, et al. Association between serum interleukin-6 concentration and mortality in patients with coronary artery disease. Mediators Inflamm. 2013; 2013:726178-. doi: 10.1155/2013/726178.
  35. Ridker PM, Rane M. Interleukin-6 signaling and anti-interleukin-6 therapeutics in cardiovascular disease. Circ Res. 2021; 128(11):1728-46. doi: 10.1161/CIRCRESAHA.121.319077.
  36. Fatemi SS, Hasanzadeh M, Arghami A, Sargolzaee MR. Lipid profile comparison between opium addicts and non-addicts. J Teh Univ Heart Ctr. 2008; 3(3):169-72.
  37. Rahimi N, Gozashti MH, Marefati H, Rahnama K, Aghaei I, Moosazadeh M. Prevalence of cardiovascular risk factors in diabetic patients and its relationship with opium consumption. J Guil Uni Med Sci. 2014; 22(88):49-57.
  38. Penno G, Solini A, Orsi E, Bonora E, Fondelli C, Trevisan R, et al. Non-albuminuric renal impairment is a strong predictor of mortality in individuals with type 2 diabetes: The renal insufficiency and cardiovascular events (RIACE) Italian multicentre study. Diabetologia. 2018; 61(11):2277-89. doi: 10.1007/s00125-018-4691-2.