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Drug overdose and the risk of cardiovascular diseases: a nested case–control study



North America has been experiencing an unprecedented epidemic of drug overdose. This study investigated the associations of drug overdose with the risk of cardiovascular disease (CVD) and 11 major CVD subtypes.


This nested case–control study was based on a cohort of 20% random sample of residents in British Columbia, Canada, who were aged 18–80 years and did not have known CVD at baseline (n = 617,863). During a 4-year follow-up period, persons who developed incident CVD were identified as case subjects, and the onset date of CVD was defined as the index date. For each case subject, we used incidence density sampling to randomly select up to five control subjects from the cohort members who were alive and did not have known CVD by the index date, were admitted to an emergency department or hospital on the index date for non-CVD causes, and were matched on age, sex, and region of residence. Overdose exposure on the index date and each of the previous 5 days was examined for each subject.


This study included 16,113 CVD case subjects (mean age 53 years, 59% male) and 66,875 control subjects. After adjusting for covariates, overdose that occurred on the index date was strongly associated with CVD [odds ratio (OR), 2.9; 95% confidence interval (CI), 2.4–3.5], especially for arrhythmia (OR, 8.6; 95% CI, 6.2–12.0), ischemic stroke (OR, 5.3; 95% CI, 2.0–14.1), hemorrhagic stroke (OR, 3.1; 95% CI, 1.2–8.3), and myocardial infarction (OR, 3.0; 95% CI, 1.5–5.8). The CVD risk was decreased but remained significantly elevated for overdose that occurred on the previous day, and was not observed for overdose that occurred on each of the previous 2–5 days.


Drug overdose appears to be associated with increased risk of cardiovascular diseases.

Graphic abstract

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Fig. 1
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British Columbia


Confidence interval


Chronic obstructive pulmonary disease


Cardiovascular disease


Emergency department


International Classification of Diseases


Ischemic heart disease


Myocardial infarction


National Ambulatory Care Reporting System


Odds ratio


Socioeconomic status


Substance use disorder


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Data for this publication were provided by the BC Coroners Service, the BC Emergency Health Services, the BC Drug and Poison Information Centre, the BC Ministry of Health (Discharge Abstract Database, National Ambulatory Care Reporting System, Medical Services Plan, and PharmaNet), and the Emergency Departments in Interior, Island, and Northern Health Authorities. All inferences, opinions, and conclusions are those of the authors, and do not reflect the opinions or policies of the data stewards.


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Correspondence to Wen Qi Gan.

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Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

This study was conducted using de-identified administrative health data from the BC Provincial Overdose Cohort as part of the provincial response to the epidemic of drug overdose; therefore, institutional ethics approval was not required.

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Gan, W.Q., Buxton, J.A., Palis, H. et al. Drug overdose and the risk of cardiovascular diseases: a nested case–control study. Clin Res Cardiol (2021).

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  • Cardiovascular diseases
  • Case–control studies
  • Drug overdose
  • Epidemiology
  • Opioid-related disorders
  • Risk factors