The results show the deleterious effect of opium on some traditional and new CVD risk factors including HbA1c, HDL-C, Lpa, apo B, factor VII, fibrinogen, apo A and CRP. Lpa which was significantly more in opium addicted is an independent risk factor for premature atherosclerosis [6, 7]. High levels of CRP and clotting factors that was seen in the opium addicts in the present study, suggest that use of opium increase risk for heart attack or stroke. Inflammation is recognized as a major etiologic determinant of multiple disease states including myocardial infarction, stroke, diabetes, and metabolic syndrome, and individuals with elevated levels of the inflammatory biomarkers such as CRP are at increased risk of mortality and morbidity from these conditions.
The presenting association between Fibrinogen and CHD beyond 10 years may imply a casual effect and also there is association between Factor VII and CHD. Studies have shown that apoB and apo A are strongly predictors of myocardial infarction and future cardiovascular events Meanwhile, reduction of HDL-C in opium addicts was significant. Numerous clinical and epidemiological studies have demonstrated that plasma concentrations of HDL-C and apo A are inversely linked with CVD . Both HDLC and apoA have antioxidant, anti-thrombotic, anti-inflammatory properties, which may be related to their anti-atherogenic function [12–14].
Even though, FBS reduced in the opium addicted subjects but it was not significant. Furthermore, the reduction of FBS was concurrent with increase in HbA1C level then it could be concluded that reduction of FBS was not a valuable outcome because HbA1c provides an integrated measurement of blood glucose during previous 2–3 months, reflecting 120-day life span of erythrocytes . Also other study is revealed that opium might decrease blood glucose temporarily . These findings are also in agreement with Karam et al.  that HbA1C was higher in the opium addict non-insulin-dependent diabetes mellitus (NIDDM) men compared to non-opium addict NIDDM male. They have also reported that opium addiction in NIDDM subjects increased serum glucose and decreased HDL-C; and thus progress to metabolic disorders in NIDDM patients.
As it expected in all the routes, there was a direct correlation between blood morphine concentration and period of addiction. Repeated use of opiate drugs, such as morphine, leads to the development of tolerance and dependence  which it result in excessive drug consumption. Then it is usual that blood morphine concentration augments when the duration of addiction increase. Although, in all the duration the higher morphine concentration was reported in the route of orally but the worst effect was observed in "Sikh-Sang". This observation suggests that destructive effects of opium are related to other compounds in opium or may be the route of administration influence diverse metabolic pathways by different mechanisms. Even though, the mechanisms of these differences are not clear but different outcomes have been mentioned for various routes of opium administration. For example, it has been reported that the onset of action of opium is delayed after oral ingestion of opium (contains morphine and codeine), because opium is poorly absorbed in the stomach but well absorbed in the small intestine.
In contrast, vaporized morphine produced by smoking of opium is rapidly absorbed across the lungs into the blood stream, and within a few seconds is available at the brain. Hence the onset of action is more rapid after smoking; however, the duration of action is longer after oral ingestion . This is also in agree with several reports that shown orally administrated addictive substances such as cannabinoids have a slower onset of action but due to the rapid delivery to the brain, they are more addictive when smoked than when administered by other routes [19, 20]. By the way, it has been reported that morphine increases hormones such as adrenalin, noradrenalin, corticosterone, prolactin and glucagons which affect the metabolism in different ways . Short- and long-term effects of morphine on the hormone secretion are different.
The reduction of TG, Ch, and LDL which was observed in the opium addicts in the present study were not significant. Furthermore, one of the main factors influencing blood lipids that are not taken into account in this study is the diet. On the other hand, nutritional habits, social status and unfavorable lifestyle behaviors could influence the blood lipid profile in a person. Usually the opium addicts have malnutrition may be due to economical problems, they prefer to save their money for buying opium instead food or loss of appetite due to the effect of opium. It is worthy to consider that this study indicate the level of cardiovascular risk factors are significantly more in opium addicted men than smoker men, while smoking is one of the important risk factor of cardiovascular disease and cancer[22–24], therefore the deleterious effects of opium addiction on cardiovascular disease are considerable.
Route of administration impresses cardiovascular risk factors and "Sikh-Sang" showed the worst effect. Effect of different temperatures on opium compounds during certain routes, effect of pipe on filtration of opium smoke in "Vafour" and effect of digestive enzymes on opium compounds during orally route should be more investigated.