ADHD Medications Not Found to Impact Cardiovascular Disease Risk

No link was found between the use of medications for attention-deficit hyperactivity disorder (ADHD) and the risk developing various cardiovascular diseases, according to a study published online in JAMA Network Open.

The study authors evaluated evidence on a potential link between ADHD drugs and the risk for a broad range of cardiovascular diseases. Although the use of ADHD medications are more common than they were over the past several decades, cardiovascular safety concerns have persisted.

“While evidence from randomized clinical trials (RCTs) suggests ADHD medications are efficacious in reducing core ADHD symptoms, there are concerns about their cardiovascular safety,” the study authors wrote. “As ADHD medications are sympathomimetic agents that exert dopaminergic and noradrenergic effects, increasing heart rate and blood pressure is biologically plausible.”

The study authors examined various databases up to May 1, 2022, seeking observational studies on the link between ADHD drugs and cardiovascular disease risk. These ADHD medications included both stimulants and nonstimulants. The study authors searched for main outcomes of any type of cardiovascular event, such as hypertension, ischemic heart disease, cerebrovascular disease, heart failure, venous thromboembolism, tachyarrhythmias, and cardiac arrest.

The investigators identified 19 studies with 3.9 million children, adolescent, and adult participants from 6 countries or regions. The final analysis included 14 cohort studies with a median follow-up time that ranged from 0.25 to 9.5 years.

The pooled adjusted relative risk did not show a statistically significant link between the use of ADHD drugs and any cardiovascular disease among children and adolescents (RR, 1.18; 95% CI, 0.91-1.53), young or middle-aged adults (RR, 1.04; 95% CI, 0.43-2.48), or older adults (RR, 1.59; 95% CI, 0.62-4.05). Additionally, the study authors did not find a significant association based on stimulants (RR, 1.24; 95% CI, 0.84-1.83) and nonstimulants (RR, 1.22; 95% CI, 0.25-5.97).

They also did not find a statistically significant association for specific cardiovascular outcomes related to cardiac arrest or arrhythmias (RR, 1.60; 95% CI, 0.94-2.72), cerebrovascular diseases (RR, 0.91; 95% CI, 0.72-1.15), or myocardial infarction (RR, 1.06; 95% CI, 0.68-1.65).

Further, there was no association identified with any cardiovascular disease in female patients (RR, 1.88; 95% CI, 0.43-8.24) or in those with preexisting cardiovascular disease (RR, 1.31; 95% CI, 0.80-2.16).

The study authors noted that despite a lack of data supporting cardiovascular disease history as a contraindication for ADHD medications, FDA labeling includes a warning about the use of these medications among patients with structural cardiac abnormalities or other serious heart problems.

“Overall, our meta-analysis provides reassuring data on the putative cardiovascular risk with ADHD medications, but the possible associations with cardiac arrest or tachyarrhythmias, among female patients, and among those with preexisting CVD warrants further investigation,” the study authors wrote. “Importantly, our findings are presented at the population level; in clinical practice, specific individuals with ADHD might be particularly prone to negative cardiovascular outcomes; therefore, clinicians should discuss with their patients and families the possible cardiovascular risk of ADHD medication in light of the latest evidence, and they should rigorously follow clinical guidelines that suggest monitoring of blood pressure and heart rate at baseline and each medication review.”

Reference

Zhang L, Yao H, Li L, et al. Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(11):e2243597. doi:10.1001/jamanetworkopen.2022.43597