ADHD medication use carries no excess risk of cardiovascular diseases

Users of attention-deficit/hyperactivity disorder (ADHD) medications across age groups do not appear to be at increased risk of cardiovascular diseases (CVDs), although a modest risk increase of cardiac arrest or tachyarrhythmias could not be ruled out, according to the results of a meta-analysis.

Researchers conducted an updated synthesis of evidence on whether there was any association between ADHD medications (including stimulants and nonstimulants) and the risk of a broad range of CVDs. They searched multiple online databases for relevant observational studies.

A total of 19 studies, of which 14 were cohort studies, conducted across six countries or regions were included in the analysis. Overall, there were 3,931,532 participants including children, adolescents, and adults (60.9 percent male). Median follow-up time ranged between 0.25 years and 9.5 years (median, 1.5 years).

Study quality was assessed using the Good Research for Comparative Effectiveness (GRACE) checklist, and data were synthesized using random-effects models. The endpoint was any type of CVD event, including hypertension, ischaemic heart disease, cerebrovascular disease, heart failure, venous thromboembolism, tachyarrhythmias, and cardiac arrest.

Pooled data revealed no significant association between ADHD medication use and any CVD among children and adolescents (adjusted relative risk [RR], 1.18, 95 percent confidence interval [CI], 0.91–1.53), young and middle-aged adults (RR, 1.04, 95 percent CI, 0.43–2.48), and older adults (RR, 1.59, 95 percent CI, 0.62–4.05).

Analyses of specific CVD outcomes likewise revealed that ADHD medication use had no statistically significant relationship with cardiac arrest or arrhythmias (RR, 1.60, 95 percent CI, 0.94–2.72), cerebrovascular diseases (RR, 0.91, 95 percent CI, 0.72–1.15), or myocardial infarction (RR, 1.06, 95 percent CI, 0.68–1.65).

The null association were observed for both stimulants (RR, 1.24, 95 percent CI, 0.84–1.83) and nonstimulants (RR, 1.22, 95 percent CI, 0.25–5.97), as well as in female patients (RR, 1.88, 95 percent CI, 0.43–8.24) and in those with pre-existing CVD (RR, 1.31, 95 percent CI, 0.80–2.16). Heterogeneity between studies was high and significant except for the analysis on cerebrovascular diseases.