{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:10:45Z","timestamp":1793653845266,"version":"4.5.1"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"15","license":[{"start":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T00:00:00Z","timestamp":1754697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Chronic opioid exposure (COE) is linked to adverse health outcomes, but its relationship with cardiovascular disease (CVD) remains unclear. This systematic review and meta-analysis aimed to summarize published evidence on CVD risk associated with COE, including prescription opioids, opium use, and opioid use disorder (OUD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and International Prospective Register of Systematic Reviews registration (CRD42024573206), we searched multiple databases for relevant human studies reporting associations between COE and CVD. Random-effects meta-analysis estimated pooled odds ratios (ORs) with 95% confidence intervals. Subgroup analyses and meta-regression explored associations by COE type, CVD outcome, and potential moderators. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies - of Exposures. Seventeen studies (1 676 000 participants) met inclusion criteria, with 13 studies contributing 22 effect sizes to meta-analysis. Chronic opioid exposure was associated with increased CVD risk (pooled OR, 1.74; 95% CI, 1.12\u20132.70), though substantial heterogeneity was observed. Cerebrovascular accidents (OR, 1.84; 95% CI, 1.45\u20132.35) and ischaemic heart disease (OR, 1.51; 95% CI, 1.40\u20131.63) showed the strongest associations. Opium use had a significant association with CVD, whilst findings for OUD and prescription opioids were less consistent. Meta-regression identified study design as a key moderator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Chronic opioid exposure is associated with increased risk of CVD, particularly cerebrovascular accidents and ischaemic heart disease. Given the global opioid and CVD burden, targeted interventions and integrated care approaches are needed. Findings are limited by heterogeneity and risk of bias in published studies. Further high-quality research should explore pathophysiological mechanisms, causality, dose\u2013response relationships, and the potential reversibility of CVD risk following opioid cessation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf500","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T11:46:11Z","timestamp":1754567171000},"page":"2771-2784","source":"Crossref","is-referenced-by-count":8,"title":["Association between chronic opioid exposure and cardiovascular disease: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1307-2375","authenticated-orcid":false,"given":"Joe","family":"Schofield","sequence":"first","affiliation":[{"name":"School of Medicine, University of St Andrews , North Haugh, St Andrews KY16 9TF 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