DOI: 10.1192/j.eurpsy.2026.10871 ISSN: 0924-9338

Elevated Cardiovascular Risk and Mortality in Type 2 Diabetes Patients with Cannabis, Opioid, and Cocaine Use Disorders

S.-K. Kao, M.-J. Lu, Y.-T. Yu
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Introduction

Substance use disorders (SUDs), including those related to cannabis, opioids, and cocaine, are growing in prevalence and have been associated with adverse health outcomes, including elevated cardiovascular risk. Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM).

Objectives

This study aimed to evaluate the association between SUDs and major cardiovascular events and all-cause mortality among individuals with T2DM.

Methods

Using the TriNetX Research Network, we performed a retrospective cohort analysis of adults aged ≥18 years diagnosed with T2DM between January 1, 2016, and December 31, 2022. Patients with a diagnosis of an SUD, including cannabis, opioid, or cocaine use disorders, within one year prior to T2DM diagnosis were identified. Propensity score matching was conducted to balance demographics, comorbidities, and medication use between the SUD and non-SUD cohorts.

Results

After propensity score matching, there were 69,373 individuals in each group. Over a 5-year follow-up, individuals with SUDs exhibited significantly elevated risks of acute myocardial infarction (HR [95% CI] = 2.916 [2.528, 3.365], p < 0.001), atrial fibrillation (HR [95% CI] = 1.994 [1.735, 2.292], p < 0.001), heart failure (HR [95% CI] = 2.685 [2.428, 2.968], p < 0.001), and all-cause mortality (HR [95% CI] = 1.621 [1.546, 1.701], p < 0.001). Subgroup analyses demonstrated consistent risk elevation across all substance types, with the highest relative risk of mortality observed in the opioid-related disorder group (HR [95% CI] = 1.804 [1.69, 1.926], p < 0.001).

Table 1.

Risks of AMI, HF, AF and mortality in the SUD cohort and non-SUD cohort

Table 1. Long description.

Outcome
SUD
(N= 69,373)
non-SUD
(N= 69,373) Hazard ratio
(95% CI) p value
AMI
657
263 2.916 (2.528, 3.365) <.001*
HF
1,256 548 2.685 (2.428, 2.968) <.001*
AF
537 314 1.994 (1.735, 2.292) <.001*
Mortality
4,074 2,836 1.621 (1.546, 1.701) <.001*
*

Indicates statistical significance ( p < .05). SUD Substance use disorder; AMI Acute myocardial infarction; AF Atrial fibrillation; HF Heart failure; HR Hazard ratio; CI Confidence interval.

Fig. 1. Cohort flowchart.

Fig. 2. Kaplan–Meier curves of CV events and mortality in T2DM with vs. without SUD (95% CI shaded).

Fig. 3. Subgroup analysis by substance type; 95% CI lower limit >1 indicates higher risk.

Abbreviations

T2DM, type 2 diabetes mellitus; SUD, substance use disorder; AMI, acute myocardial infarction; AF, atrial fibrillation; HF, heart failure; HR, hazard ratio; CI, confidence interval.

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Conclusions

The presence of an SUD is associated with a markedly increased risk of cardiovascular morbidity and all-cause mortality in individuals with T2DM. These findings underscore the need for integrated cardiovascular risk stratification and the implementation of tailored preventive and therapeutic strategies for this high-risk population.

Disclosure of Interest

None Declared

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