Stimulants may be associated with an elevated short-term risk of cardiovascular (CV) problems such as ventricular arrhythmia and stroke in older patients, according to new data published in JAMA Pharmacy and Clinical Pharmacology. The effect, however, appears to fade as time goes on.
While previous studies have examined the relationship between stimulant use and CV events in children and young adults, the authors set out to learn more about outcomes in patients 66 years old and older. They analyzed data from 6,457 patients who were prescribed a stimulant and 24,853 patients who received a placebo.
Data was extrapolated from several population-based health care databases at ICES in Toronto. All patients were treated from January 2002 to December 2016.
Forty-nine percent of the patients were men, and the mean patient age was 74 years old.
The study's primary outcome was a CV event, described as the composite of emergency department visits or hospitalizations for MI, stroke, transient ischemic attack (TIA) or ventricular arrhythmia.
According to the authors, stimulant use was tied to a 40% increase in CV events within 30 days of initiation, but not at 180 days or 365 days.
The team also found that stimulant initiation was linked with a greater risk of ventricular arrhythmias, stroke or TIA at 30 days.
“Our results suggest the importance of studying drug safety among older adults separately given that meaningful differences exist between this population and others, such as differing pharmacodynamic outcomes and increased prevalence of comorbidities (eg, risk of underlying CV disease),” wrote lead author Mina Tadrous, PharmD, PhD, with the Leslie Dan Faculty of Pharmacy at the University of Toronto, and colleagues. “The evidence gap with prescription stimulant use is even more concerning given the rapid increase in stimulant uptake for a variety of indications.”
Tatrous et al. noted that the results from the study could add greater certainty to a mixed body of evidence throughout the older adult population.
“Our findings do not suggest that clinicians should decrease vigilance in prescribing these agents, but rather suggest that current prescribing practices in patient selection should be continued," they wrote.
Read the full study here.