Adults with attention-deficit/hyperactivity disorder (ADHD) are often treated with stimulants such as mephyphenidates and amphetamines, and additionally with a newer non-stimulant agent, atomoxetine. Placebo-controlled studies have shown that all of these drugs are capable of increasing systolic and diastolic blood pressure in addition to heart rate. However, no clinical trial to date has been large enough to assess whether these physiological changes lead to an increase in cardiovascular events. Therefore the aim of this study was to investigate whether the current use of medications used primarily to treat ADHD leads to an increase in the risk of myocardial infarction (MI), sudden cardiac death (SCD), or stroke in adults aged 25-64. For the purposes of the study, indeterminate use was the first 89 days after end of current use, former use began at 90 days after end of current use and ended at 364 days after last current use, and remote use referred to more than 364 days since the end of the last days supply.
During 806,182 person-years of follow-up, 1357 cases of MI, 296 cases of SCD, and 575 cases of stroke were documented. The multivariable-adjusted rate ratio (RR) of serious cardiovascular events for current users vs non-users of ADHD medications was 0.83 (95% CI, 0.72-0.96). The adjusted RR for current users vs remote users was 1.03 (95% CI, 0.86-1.24); for new users vs remote users, the adjusted RR was 1.02 (95% CI, 0.82-1.28). There was a crude incidence per 1000 person-years of 1.34 (95% CI, 1.14-1.57) for MI, 0.30 (95% CI, 0.20-0.42) for SCD, and 0.56 (95% CI, 0.43-0.72) for stroke.
In this study, the use of ADHD medications was not associated with an increased risk of serious cardiovascular events. An apparent protective effect may be due to healthy-user bias in this cohort.
- Habel LA, Cooper WO, Sox CM et al. ADHD Medications and Risk of Serious Cardiovascular Events in Young and Middle-aged Adults. JAMA 2011;306:2673-2683.