Attention-deficit/hyperactivity disorder (ADHD) medications are not associated with a significant risk of developing cardiovascular disease (CVD), according to a new meta-analysis published in JAMA Network Open.[1] However, the authors noted, “a modest risk increase could not be ruled out.”
“ADHD medications, including both stimulants and nonstimulants, are recommended for pharmacological treatment of ADHD, and the prevalence of ADHD medication use among both children and adults has increased substantially in many countries. ,” wrote first author Le Zhang, MPH, with the department of medical epidemiology and biostatistics at Karolinska Institute in Sweden, and colleagues. “While evidence from randomized clinical trials (RCTs) suggests ADHD medications are efficacious in reducing core ADHD symptoms, there are concerns about their cardiovascular safety. As ADHD medications are sympathomimetic agents that exert dopaminergic and noradrenergic effects, increasing heart rate and blood pressure is biologically plausible.”
Zhang et al. included 19 studies in their meta-analysis, examining data from nearly 4 million patients in total. Patients were from the United States, South Korea, Canada, Denmark, Spain and Hong Kong.
Overall, ADHD medications were not found to be significantly associated with the risk of CVD among children and adolescents, young and middle-aged adults or older adults. This was also the case when looking at the study’s overall patient population. The group emphasized that there was “no evidence of publication bias” and “the estimate was not driven by a single study.”
The group also looked at specific cardiovascular outcomes, noting that ADHD medications were not linked to an increased risk of cardiac arrest, arrhythmia, cerebrovascular disease or myocardial infarction.
One finding that stood out was that two of the included studies did suggest ADHD medications could increase the CVD risk among patients who already have a history of CVD. This was not identified as a potential factor in the other 17 studies, however.
“To our knowledge, this is the most comprehensive systematic review and meta-analysis of longitudinal observational studies on the association between ADHD medication use and the risk of CVD,” the authors wrote.
The group did note that more research is needed.
“Further studies focusing on the potential modifying risk of preexisting CVD, ideally separating risks for congenital or acquired CVD, are warranted,” they wrote. “Clinical guidelines on prescribing ADHD medications among high-risk individuals should be updated once further evidence is available.”
In addition, since prior studies had found that ADHD can have a different impact on female patients, Zhang and colleagues said additional research comparing CVD risk among male and female patients taking these medications is warranted.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.