The cardiovascular safety of attention-deficit/hyperactivity disorder (ADHD) medications has been studied previously with mixed findings, in part due to study bias. A recent systematic review and meta-analysis examined observational studies that investigated the association between ADHD medications (stimulants and nonstimulants) and cardiovascular disease (CVD). Using rigorous quality assessment to account for bias, 19 studies with 3,931,532 participants (children, adolescents, and adults; 60.9% male) were analyzed. Studies included participants from the United States, South Korea, Canada, Denmark, Spain, and Hong Kong. Average follow-up time ranged from 0.25 to 9.5 (median 1.5) years, with 10 studies including incident users and 9 studies including prevalent users. Pooled adjusted relative risk (RR) did not show significant associations between ADHD medication use and any CVD 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). Subgroup analyses of medication type (stimulant or nonstimulant), specific CVD outcomes (cardiac arrest or tachyarrhythmias, cerebrovascular diseases, or myocardial infarction), sex (male or female), and history of CVD (yes or no) also did not yield statistically significant effects. However, higher point estimates were observed for cardiac arrest or tachyarrhythmias (pooled RR=1.60), females (pooled RR=1.88), and those with history of CVD (pooled RR=1.31). Despite a lack of statistical significance, a modest risk in CVD increase could not be ruled out, especially for the risk of cardiac arrest or tachyarrhythmias, and particularly among females and those with a history of CVD. Future well-designed studies of these sub-groups are warranted.

Reference:

Zhang L et al. JAMA Netw Open 2022;5(11):e2243597. Abstract.