Study finds no cardiovascular effects of attention-deficit hyperactivity disorder drugs

An analysis of the cardiovascular safety of drugs used to treat attention-deficit/hyperactivity disorder (ADHD) in a population of more than 1.2 million children and young adults from 4 geographically diverse health plans with more than 2.5 million person years of follow-up found no evidence that these drugs increase the risk of serious cardiovascular events. Study data ranging from 1986 to 2002 was obtained from computerized health records of patients aged from 2 to 24 years receiving an ADHD medication, including methylphenidate, dexmethylphenidate, dextroamphetamines, amphetamine salts, atomoxetine, or pemoline.

For each patient receiving an ADHD medication, investigators randomly selected for comparison up to 2 nonuser controls from health plan members at the same site. The health plans supplying data were Tennessee Medicaid, Washington State Medicaid, Kaiser Permanente California, and OptumInsight Epidemiology.

Only 81 patients in this study taking ADHD medications, or 3.1 per 100,000 person years, had a serious cardiovascular event (sudden cardiac death, myocardial infarction, or stroke). The adjusted rate of serious cardiovascular events did not differ significantly among current users of ADHD drugs, former users, and nonuser controls (Cooper WO, et al. N Engl J Med. 2011;365[20]:1896-1904).

This very large, retrospective, cohort study offers significant reassurance to physicians who were unnerved by the 2006 US Food and Drug Administration black box warning about cardiac adverse events attributed to ADHD medications. In a 2008 policy statement, the AAP recommended a targeted cardiac history (including family history) and physical exam for patients beginning stimulant medications for ADHD. Routine electrocardiograms are not recommended (Pediatrics. 2008;122[2]: 451-453).-Michael Burke, MD