ADHD and CV Issues 2

No Increased Risk of Cardiovascular Events in Adults Who Take ADHD Medications

Print This Post Print This Post

A new study published in JAMA[1] has found no evidence of an increased risk of heart attack, stroke, or sudden cardiac death in young and middle-aged adults who use medications to control attention-deficit/hyperactivity disorder (ADHD). The medications studied include stimulants (amphetamine products and methylphenidate), atomoxetine, and pemoline [no longer marketed; Table 1]) and the study was funded by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, the Food and Drug Administration (FDA), and the National Institute on Aging.

'

According to background information in the article, use of medications approved for ADHD treatment increased faster in adults than in children between 2001 and 2010.[2] A 2006 FDA advisory committee briefing on ADHD medication safety stated that 32% of all stimulants issued in the United States were adult-prescribed and more than 1.5 million U.S. adults were taking the medication.[3] In early placebo-controlled studies in children and adults, these agents were noted to increase heart rate and blood pressure,[4,5] raising concerns about their cardiovascular safety. However, until now, clinical trials were not large enough to assess risk of these events.

In this new study, researchers examined whether medications used primarily to treat ADHD are associated with an increased risk of heart attack, sudden cardiac death, or stroke in adults. The researchers used computerized health records from four study sites, starting in 1986 at one site and ending in 2005 at all sites, with an additional assessment using 2007 survey data. The more than 150,000 participants were between the ages of 25 and 64 years and had received prescriptions for methylphenidate, amphetamine, or atomoxetine. Each medication user was matched to two nonusers by study site, birth year, sex, and calendar year, for a total of 443,198 users and nonusers.

During follow-up, there were 1,357 cases of heart attacks, 575 cases of stroke, and 296 cases of sudden cardiac death. Data analysis suggested that patients who were currently or had just begun taking ADHD medications were at no greater risk for serious cardiovascular events than those patients who never, or had not recently, taken the medication. There appeared to be no association between any specific medication and a cardiac event or with longer duration of current use. The Medicaid population event rates were substantially higher, which was not unexpected.

Furthermore, results were similar when restricting the category of users to new users or to those with or without ADHD. Results also were similar when the comparison was restricted to those with or without evidence of prior cardiovascular disease or to those with or without evidence of prior non-ADHD psychiatric conditions. In addition, results were similar for participants who were the ages of 25 through 44 and 45 through 64 years during follow-up.

FDA recommendations for the use of medications to treat ADHD have not changed. Healthcare professionals should continue to take special note that

  • Stimulant products and atomoxetine should generally not be used in patients with serious heart problems, or for whom an increase in blood pressure or heart rate would be problematic.
  • Patients treated with ADHD medications should be periodically monitored for changes in heart rate or blood pressure.
  • Patients should continue to use their medicine for the treatment of ADHD as prescribed by their healthcare professional.

On November 1, 2011, the FDA communicated the results of a study in children and young adults treated with ADHD medications that also did not show an increased risk of serious cardiovascular events. To read more on this study, see ADHD Medications and Cardiovascular Complications.

Jill Shuman, MS, ELS
Published December 20, 2011

 

References

  1. Habel LA, Cooper WO, Sox CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults [published online before print December 12, 2011]. JAMA. 2011;306(24): doi: 10.1001/jama.2011.1830.
  2. New Report: America’s State of Mind. Medco Website. http://medco.mediaroom.com/. 2011. Cited by: Habel LA, Cooper WO, Sox CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults [published online before print December 12, 2011]. JAMA. 2011;306(24): doi: 10.1001/jama.2011.1830.
  3. Food and Drug Administration. Drug Safety and Risk Management Advisory Committee meeting. Food and Drug Administration Website. http://www.fda.gov/ohrms/dockets/ac/cder06.html#DrugSafetyRiskMgmt. February 9-10, 2006. Cited by: Habel LA, Cooper WO, Sox CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults [published online before print December 12, 2011]. JAMA. 2011;306(24): doi: 10.1001/jama.2011.1830.
  4. Hammerness PG, Surman CB, Chilton A. Adult attention-deficit/hyperactivity disorder treatment and cardiovascular implications. Curr Psychiatry Rep. 2011;13(5):357-363. Cited by: Habel LA, Cooper WO, Sox CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults [published online before print December 12, 2011]. JAMA. 2011;306(24): doi: 10.1001/jama.2011.1830.
  5. Stiefel G, Besag FM. Cardiovascular effects of methylphenidate, amphetamines and atomoxetine in the treatment of attention-deficit hyperactivity disorder. Drug Saf. 2010;33(10):821-842. Cited by: Habel LA, Cooper WO, Sox CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults [published online before print December 12, 2011]. JAMA. 2011;306(24): doi: 10.1001/jama.2011.1830.