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In many Asian and Middle Eastern countries such as Iran, the common use of opium as a treatment for cardiovascular problems has been discussed. Nevertheless, there are few studies to prove or disprove this belief (1). However, to the best of our knowledge, several studies have been carried out to address the effects of opium on cardiovascular disease and its risk factors but very low comprehensive article has been written regarding its effect on mortality of CVD, so our clinical question was raised in this specific area of care. To answer this clinical question, the literature search was performed. A review of the abstracts of these articles led to the selection of one article (2) that assessed the effects of opium on overall and cause-specific mortality. This study is the largest cohort study in Iran and has the highest relevance to our clinical question and also the highest level of evidence, so we decided to appraise this topic critically (CAT it). For critical appraisal of this topic, we selected a tool which is a critical appraisal tool relating to public health issues (3). This study is a prospective cohort study with large sample size and prior validation of exposure and outcome measurements and the follow-up information of participants for over 99% was obtained. This study would have Level 2b evidence and strength of recommendation Grade B. In this study, the cause of death in 35% of the cases was determined just based on verbal autopsy which can cause bias in the measurement. Moreover, the blinding of the person who performed statistical analysis on the exposure data was not mentioned. It can cause analytical bias.

Effects of Opium Use on Cardiovascular Mortality: A Critical Appraisal of a Topic