Study finds no increased risk of serious cardiovascular events among adults who use ADHD medications

December 12, 2011

CHICAGO - Although there have been cardiovascular safety concerns about attention-deficit/hyperactivity disorder (ADHD) medications because of their ability to increase heart rate and blood pressure levels, an analysis that included more than 150,000 ADHD users found no evidence of an increased risk of heart attack, stroke or sudden cardiac death associated with current use compared with nonuse or rare use among young and middle-aged adults, according to a study appearing in JAMA. The study is being released early online because of its public health importance.

"Between 2001 and 2010, use of medications labeled for treatment of ADHD increased even more rapidly in adults than in children. According to a 2006 U.S. Food and Drug Administration (FDA) advisory committee briefing on the safety of ADHD medications, more than 1.5 million U.S. adults were taking stimulants in 2005, and adults received approximately 32 percent of all issued prescriptions," according to background information in the article. "Placebo-controlled studies in children and adults indicate that stimulants and atomoxetine [a medication used to treat ADHD] elevate systolic blood pressure levels by approximately 2 to 5 mm Hg and diastolic blood pressure levels by 1 to 3 mm Hg and also lead to increases in heart rate. Although these effects would be expected to slightly increase risk for myocardial infarction [MI; heart attack], sudden cardiac death (SCD), and stroke, clinical trials have not been large enough to assess risk of these events."

Laurel A. Habel, Ph.D., of Kaiser Permanente Northern California, Oakland, and colleagues examined whether medications used primarily to treat ADHD are associated with an increased risk of heart attack, SCD, or stroke in adults. The researchers used computerized health records from 4 study sites, starting in 1986 at 1 site and ending in 2005 at all sites, with an additional assessment using 2007 survey data. Participants were adults 25 through 64 years of age with dispensed prescriptions for methylphenidate, amphetamine, or atomoxetine. Each medication user (n = 150,359) was matched to two nonusers on study site, birth year, sex, and calendar year (total users and nonusers = 443,198).

During follow-up, there were 1,357 cases of heart attacks, 296 cases of sudden cardiac death, and 575 cases of stroke. After analyses of the data, the researchers found that current or new use of ADHD medications, compared with nonuse or remote use, was not associated with an increased risk of serious cardiovascular events, such as heart attack, sudden cardiac death, or stroke. "We also found little support for an increased risk for any specific medication or with longer duration of current use. Results were similar when users were restricted to new users. Rate ratios did not appear to be influenced by prior cardiovascular disease or by prior non-ADHD psychiatric conditions. They also were similar across age groups. As expected, event rates were substantially higher in the Medicaid population; however, the rate ratio for current use was similar to that in other sites," the authors write.

The researchers also found that among ever users of ADHD medications, the adjusted rate ratio of serious cardiovascular events was nearly the same during periods of current use as during follow-up periods more than 1 year after use ended. Cardiovascular diseases were similar or slightly more prevalent in new users than nonusers.

The authors note that a modestly elevated risk of serious cardiovascular events cannot be ruled out, given limited power of the study and a lack of complete information on some potentially important risk factors and other factors related to use of these medications.

(DOI:10.1001/JAMA.2001.1830; Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: ADHD Medications and Cardiovascular Risk - Some Heartening News

In an accompanying editorial, Philip Shaw, M.D., Ph.D., formerly of the National Institute of Mental Health (currently with the Human Genome Research Institute), Bethesda, Md., writes that the findings of this study raise several clinically important issues.

"First, the findings support the final decision by the FDA in 2006 not to place a black box warning of serious cardiovascular events on ADHD medications for all children and adults but to pursue further research. The findings, however, do not directly inform the current black box warning for psychostimulants, which is confined to patients with structural heart lesions. The study focused on very rare events, which prevented examination of specific subgroups such as individuals with cardiac disease. Joint care by cardiologists and other physicians remains necessary for these individuals. In addition, the study provides no evidence to support routine obtaining of electrocardiograms before starting treatment, certainly insofar as this recommendation was driven by concerns about serious cardiovascular events."

(DOI:10.1001/JAMA.2011.1866; Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
-end-
To contact Laurel A. Habel, Ph.D., call Maureen McInaney-Jones at 510-891-3173 or email Maureen.Mcinaney@kp.org. To contact editorial author Philip Shaw, M.D., Ph.D., call Raymond MacDougall at 301-402-0911 or email macdougallr@mail.nih.gov.

The JAMA Network Journals

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.