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Heroin Addiction and Related Clinical Problems: 2022, 24, N3 (pages: 33 - 40)

Opium use and risk of stroke: a systematic review and meta-analysis

Borhani-Haghighi A., Tabrizi R., Estakhr M., Hosseini-Bensenjan M., Niknam M., Iravani Saadi M., Moazzen F., and Nowrouzi-Sohrabi P.

Summary: Background: Stroke prevention is currently developing at a level superior to its treatment; as a result, studies have trended to follow the path of defining its risk factors. Physicians have conflicting views about the role of opium in stroke development. Methods: Monitoring of the medical literature was systematically conducted up to August 21, 2020, mainly by using online databases including MEDLINE/PubMed, Scopus, Embase, and Web of Science (WOS). Q-test and I2 statistics were used to assess the heterogeneity between the various studies examined in the present study. Results: Out of a total of 1995 records, 6 eligible articles were selected to include our meta-analysis. By applying the random-effect model, the pooled results showed that opium use significantly affected stroke risk based on estimates of the effects of crude OR 2.09 (95% CI: 1.08, 4.05), whereas it had no significant effects on adj OR 1.58 (95% CI: 0.79, 3.16). For pooled crude OR, however, we did find a significant association between opium use and the risk of stroke in studies that were carried out with a case-control design (crude OR= 4.17; 95%CI: 2.76, 6.28; I2: 0.00%, P=0.783) and on all types of stroke (crude OR= 2.26; 95%CI: 1.04, 4.93; I2: 68.41%, P=0.001) vs. other strata. When stratified for pooled adj OR, significant associations between opium use and stroke risk were found in studies that were carried out with a case-control design (adj OR= 2.57; 95%CI: 1.63, 4.06; I2: 0.00%, P=0.844) and smoking adjustment (adj OR= 2.41; 95%CI: 1.54, 3.77; I2: 0.00%, P=0.704). Moreover, a sensitivity analysis indicated that, after excluding the source of heterogeneity, the pooled crude OR 2.86 (95%CI: 1.84, 4.43, P<0.001) and adj OR 2.27 (1.59–3.24, P <0.001) were significantly associated with stroke risk among opium users, when they were compared with controls. Conclusion: Results of the current meta-analysis showed that opium consumption is an independent potential risk factor for stroke; it is, therefore, necessary to decrease opium use, with the objective of reducing the risk of stroke development.