Attention deficit hyperactivity disorder (ADHD) medication use was not associated with increased risk of cardiovascular disease (CVD), a systematic review and meta-analysis of 19 studies showed, although researchers cautioned that a modest increase of risk cannot be completely ruled out.
Among more than 3 million people, there were no statistically significant associations between ADHD medication use and any CVD risks among children and adolescents (relative risk [RR] 1.18, 95% CI 0.91-1.53), young or middle-aged adults (RR 1.04, 95% CI 0.43-2.48) or older adults (RR 1.59, 95% CI 0.62-4.05) during a median follow-up ranging from 0.25 to 9.5 years, reported Le Zhang, MPH, of the Karolinska Institutet in Stockholm, and co-authors.
When analyzing specific cardiovascular outcomes, there were no statistically significant associations between ADHD medication use and cardiac arrest or arrhythmias (RR 1.60, 95% CI 0.94-2.72), cerebrovascular disease (RR 0.91, CI 95% 0.72-1.15) or myocardial infarction (RR 1.06, 95% CI 0.68-1.65), observed in open JAMA network🇧🇷
Zhang and his team also found no statistically significant associations for stimulants (RR 1.24, 95% CI 0.84-1.83) or non-stimulants (RR 1.22, 95% CI 0.25-5.97).
“Overall, our meta-analysis provides reassuring data on putative cardiovascular risk with ADHD medications,” they wrote.
Although there were also no associations between ADHD medication use and any CVD in people with pre-existing CVD (RR 1.31, 95% CI 0.80-2.16) and in women (RR 1.88, 95% CI 0.43-8.24), Zhang and co – authors observed that point estimates were higher when compared to those without pre-existing conditions and for women versus men. They said more research is needed to determine possible associations in these groups.
Likewise, they said they could not rule out the possibility of a modest increase in the risk of some cardiovascular diseases, such as cardiac arrest or tachyarrhythmias, with the use of ADHD medications.
“In clinical practice, specific individuals with ADHD may be particularly prone to negative cardiovascular outcomes,” Zhang and his team wrote. “Therefore, physicians should discuss with their patients and families the possible cardiovascular risk of ADHD medication in light of the most recent evidence and should strictly follow clinical guidelines that suggest monitoring blood pressure and heart rate at baseline and at each review. of medication”.
In an accompanying editorial, Roy C. Ziegelstein, MD, of the Johns Hopkins University School of Medicine in Baltimore, noted that the study’s findings “should make us question whether these drugs — which have raised understandable concerns about CVD risk in the past — can actually be safe in that regard.”
“The truth is, we’ve been wrong before with regard to medications and CVD risk, often in the opposite direction,” he added, highlighting the use of two antiarrhythmic drugs – encainide and flecainide – for survivors of myocardial infarction, which were subsequently found to increase the risk of death from arrhythmias.
“Healthcare professionals should exercise caution and not slavishly adhere to consensus guidelines or follow meta-analyses conclusions when treating individual patients,” he concluded. While these data are “reassuring in many ways, healthcare professionals should carefully weigh these factors when prescribing ADHD medications, especially for older adults, individuals with established CVD, and those with other comorbid conditions that increase CVD risk.”
For this systematic review and meta-analysis, Zhang and colleagues included 19 studies published from 2007 to 2021, which included 3,931,532 participants, including children, adolescents, and adults (60.9% male) from six countries or regions (US, Korea, South Africa, Canada, Denmark, Spain and Hong Kong). Most were cohort studies (n = 14), and the mean follow-up time ranged from 0.25 to 9.5 years (median 1.5 years).
Zhang and his team acknowledged that “heterogeneity was high and significant for most analyses”, which was the main limitation of the study. They also noted that they could not compare CVD associations with specific ADHD medications or analyze dose-response associations.
Zhang has not reported any disclosures. Co-authors reported relationships with government entities, foundations, and pharmaceutical companies.
Ziegelstein has not reported any disclosures.