Association Between Prescription Pain Medication Use and Cardiovascular Risk Factors in US Adults: A Cross-Sectional Study Using the National Health and Nutrition Examination Survey (2017-2020)

Background Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in the United States, with risk driven by the clustering of modifiable factors such as hypertension, diabetes, obesity, dyslipidemia, and smoking. Prescription pain medication use is common among adults with chronic conditions, yet its relationship with cardiovascular risk burden is not well-characterized. Objective The objective of this study is to evaluate the association between prescription pain medication use and cardiovascular risk burden among adults in the United States. Methods This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 prepandemic cycle. Adults aged 18 years and older were included. The exposure was prescription pain medication use. The outcome was a composite cardiovascular risk burden score categorized into low, moderate, and high risk. Survey-weighted logistic regression was used to examine the association with high cardiovascular risk, adjusting for demographic and socioeconomic factors. The final analytic sample included 6,662 participants, corresponding to a weighted population of 195,893,244 US adults. Results Prescription pain medication use was associated with higher odds of high cardiovascular risk factor burden (adjusted odds ratio, 1.54; 95% confidence interval (CI), 1.15-2.07; p = 0.005). Increasing age was associated with higher odds (adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.03; p = 0.003). A higher income-to-poverty ratio was associated with lower odds (adjusted odds ratio, 0.92; 95% confidence interval, 0.85-0.99; p = 0.029). Physical activity was associated with lower odds (adjusted odds ratio, 0.53; 95% confidence interval, 0.39-0.74; p < 0.001). Conclusion Prescription pain medication use is associated with a higher cardiovascular risk factor burden among US adults. These findings support the need for integrated cardiovascular risk assessment in individuals receiving pain medications.