Abstract A016: Oral Opioid Use and Risk of Ischemic Stroke: Evidence from the ARIC Study

Background: Opioid medications are prescribed for pain management including headache treatment; recent study suggests its association with cardiovascular disease including stroke. We investigated the relationship between oral opioid use and incident ischemic stroke within the Atherosclerosis Risk in Communities (ARIC) study. Methods: We analyzed data from 11,668 ARIC participants (mean age 60 ± 6 years, 78% white and 56% female) at Visit 3 (1993–1995), including 390 opioid users, followed for ischemic stroke events. Oral opioid medication use was not assessed directly; instead, opioids would have been captured through the comprehensive medication inventory if participants brought relevant medication containers to the visit. Cox proportional hazards regression models estimated hazard ratios (HRs) for incident ischemic stroke associated with opioid use, adjusting for demographic and vascular risk factors (age, sex, race, hypertension, diabetes, smoking). Kaplan–Meier survival curves and log-rank tests compared event-free survival. Results: During follow-up, 1,011 ischemic strokes occurred, including 46 among opioid users. In univariate Cox models, opioid use was significantly associated with higher stroke risk (HR 1.59; 95% CI, 1.19–2.14; p = 0.002). In multivariable models adjusting for age, sex, race, hypertension, diabetes, smoking and atrial fibrillation, opioid use remained independently associated with incident ischemic stroke (HR 1.55; 95% CI, ~1.15–2.09; p = 0.004). Kaplan–Meier analysis ( Figure ) demonstrated significantly lower cumulative stroke-free survival among opioid users compared with non-users (log-rank χ 2 = 9.72, p = 0.002) . Conclusions: In ARIC, oral opioid use was independently associated with a ~50% increased risk of incident ischemic stroke after adjustment for established vascular risk factors. These findings highlight the need for careful risk–benefit assessment when prescribing opioids, particularly in populations with elevated cardiovascular risk.