ADHD medication use carries no excess cardiovascular disease risk

Attention-deficit/hyperactivity disorder (ADHD) medications do not appear to put users at increased risk of cardiovascular disease (CVD), although a modest risk increase for cardiac arrest or tachyarrhythmias cannot be ruled out, according to the results of a meta-analysis.

Researchers synthesized current evidence on whether ADHD medications were associated with the risk of a broad range of CVDs. They searched multiple online databases for relevant articles and identified 19 observational studies, which were conducted across six countries or regions, for inclusion in the meta-analysis.

The primary outcome was any type of cardiovascular event, including hypertension, ischaemic heart disease, cerebrovascular disease, heart failure, venous thromboembolism, tachyarrhythmias, and cardiac arrest.

The studies involved 3,931,532 participants (60.9 percent male) including children, adolescents, and adults. Median follow-up duration ranged from 0.25 to 9.5 years (median, 1.5 years).

Pooled using random-effects models, the data revealed no statistically significant association between ADHD medication use and any CVD among children and adolescents (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).

The associations remained null when ADHD medications were grouped into stimulants (RR, 1.24, 95 percent CI, 0.84–1.83) or nonstimulants (RR, 1.22, 95 percent CI, 0.25–5.97).

For specific CVD outcomes, ADHD medications showed no significant associations 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).

There were no associations with any CVD 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 was high and significant among the studies except for the analysis on cerebrovascular diseases.

More studies are needed to establish the cardiovascular risk among female ADHD medication users and users with pre-existing CVD, as well as long-term risks associated with ADHD medication use.