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ADHD Medications and Increased Risk of Heart Disease

Many children and adults have been diagnosed with ADHD (attention deficit hyperactivity disorder) and been prescribed medications as a result. Medications that are taken daily for years. The big question is: Are there long-term health effects from ADHD medications?

A large study looking at long-term use of ADHD medications found an increase in cardiovascular disease, particularly hypertension and arterial disease, when compared to persons with ADHD who did not take medications. The longer the medications were taken, the higher the risk for hypertension and arterial disease.

In the 14 year follow-up, the researchers found that each 1 year increase of ADHD medication was associated with a 4% increased risk of heart disease (cardiovascular disease). The risk was higher for stimulant medications (e.g., methylphenidate, lisdexamfetamine) than for non-stimulant medications.

From Medical Xpress: Long-term ADHD medication use associated with increased cardiovascular disease

Research led by the Karolinska Institutet, Sweden, has found an increased risk of cardiovascular disease associated with long-term ADHD ( attention-deficit/hyperactivity disorder) medication use. Specific associations with different medications and dosages were connected to hypertension and arterial disease, with a higher risk observed for stimulant medications.

Within a robust cohort of 278,027 individuals with ADHD aged 6 to 64 years, the incidence rate of CVD (cardiovascular disease)was 7.34 per 1000 person-years. The study analyzed 10,388 cases (with CVD) and 51,672 matched controls and observed higher rates of CVD in cases compared to controls.

Cases were identified based on recorded diagnoses of various types of CVD, including ischemic heart diseases, cerebrovascular diseases, hypertension, heart failure, arrhythmias, thromboembolic disease, arterial disease, and other forms of heart disease.

Controls were selected to match cases regarding age, sex, and calendar time. They were individuals who did not have a diagnosis of CVD at the time when their matched case received a diagnosis of CVD.

Meta-analyses of previous randomized clinical trials have reported increases in heart rate and blood pressure associated with both stimulant and non-stimulant ADHD medications. The clinical trials tended to be shorter term, and thus the need for a longer-term follow up.

In the current study, researchers found long-term use of stimulant methylphenidate had an adjusted odds ratio for increased risk of CVD of 20% for 3 to 5-year use and 19% for over 5-year users. Lisdexamfetamine was associated with an elevated CVD risk of 23% for 2 to 3 years and 17% for over 3 years of use. Non-stimulant atomoxetine had an increased association with CVD that was significant only for the first year of use at 7%.

ADHD is a common psychiatric condition characterized by inattentiveness, impulsivity, and hyperactivity. Pharmacological therapy often includes stimulants like methylphenidate (Ritalin, Concerta) and dextroamphetamine-AMP (Adderall). These stimulants would cause most people to feel jittery, amped-up, and anxious but are calming to those with ADHD, allowing them greater ability to focus.

Non-stimulants used in the treatment of ADHD are sometimes formulations of tricyclic antidepressants. These can be effective for ADHD symptoms yet have been associated with heart arrhythmias, and, as with any antidepressant use, off-target behavioral or psychological side effects have been reported.

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