ADHD medications do not significantly increase cardiovascular disease risk

Medications for attention-deficit/hyperactivity disorder (ADHD) are not associated with a significantly increased risk of cardiovascular diseases (CVDs), but a mild risk increase cannot be ruled out, according to a recent study.

ADHD is one of the most common neurodevelopmental disorders, with symptoms starting in childhood and often persisting into adulthood. Stimulants and nonstimulants are used for pharmacological treatment of ADHD, and the proportion of children and adults taking ADHD medications has risen in multiple countries.

Evidence has supported the efficacy of ADHD medications, but concerns have arisen over their cardiovascular safety. The dopaminergic and noradrenergic effects of ADHD medications could potentially increase heart rate and blood pressure, with some randomized clinical trials indicating short term increases in pulse or heart rate after taking methylphenidate.

Research on severe cardiovascular outcomes from ADHD medications has produced mixed results, prompting a need for updated data on the association between ADHD medications and cardiovascular events.

Investigators conducted a study to determine the association between ADHD medications and risk of cardiovascular events. A systematic search took place through PubMed, Embase, PsycINFO, and Web of Science, continuing until May 1, 2022. Observational studies on the association between ADHD medications and CVDs were collected.

Data collected on studies included year of publication, first author, sample size, data source, age and sex distribution, study design, study country, year of original data collection, follow-up time, ADHD medication type, measure of medication use, relative risk, definition of CVD, and covariate adjustment.

There were 19 studies published between 2007 and 2021 included, consisting of 3,931,532 participants across 6 countries or regions. Children, adolescents, and adults were included in the study, and about 61% of participants were male. The average follow-up time was between 0.25 and 9.5 years.

When calculating relative risks (RR), it was found that ADHD medications did not lead to a significant risk of CVDs in any of the analyzed age groups. These results were consistent across multiple studies. Subgroup analyses also did not find any significant associations between ADHD medications and CVDs.

While no significant risk was associated with ADHD medications, the pooled RR did not exclude a mild risk increase for outcomes such as cardiac arrest and tachyarrhythmias. Though this risk is relatively low, it could change in high-risk patients or those with preexisting CVD. Investigators recommended that patients follow guidelines established by their clinicians.

Reference

Zhang L, Yao H, Li L, Du Rietz E, Andell P, Garcia-Argibay M, et al. Risk of cardiovascular diseases associated with medications used in attention-deficit/hyperactivity disorder: asystematic review and meta-analysis. JAMA Netw Open. 2022;5(11):e2243597. doi:10.1001/jamanetworkopen.2022.43597