No Associations Between ADHD Medications, Cardiovascular Disease Risk Found

Le Zhang, MPH

A new analysis shows no associations between the use of attention deficit/hyperactivity disorder (ADHD) and the risk of various cardiovascular diseases.

A team, led by Le Zhang, MPH, Department of Medical Epidemiology and Biostatistics, Karolinska Institute, updated the synthesis of evidence of whether ADHD medications are linked to the risk of a broad range of cardiovascular diseases.

The Hypothesis

While ADHD medications are more commonly used now than decades ago, there remain cardiovascular safety concerns.

“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 authors wrote. “As ADHD medications are sympathomimetic agents that exert dopaminergic and noradrenergic effects, increasing heart rate and blood pressure is biologically plausible.”

Assessing the Risk

In the study, the investigators searched various databases up to May 1, 2022 for observational studies investigating the association between ADHD medications and risk of cardiovascular disease. The medications included stimulants and nonstimulants.

The investigators sought main outcomes of any type of cardiovascular event, including hypertension, ischemic heart disease, cerebrovascular disease, heart failure, venous thromboembolism, tachyarrhythmias, and cardiac arrest.

Overall, the team found 19 studies involving 3.9 million children, adolescent, and adult participants from 6 countries or regions. The final analysis included 14 cohort studies and the median follow-up time ranged from 0.25-9.5 years.

No Associations

The results show the pooled adjusted relative risk did not show a statistically significant association between ADHD medication use 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).

There were also no significant associations found based on treatments (stimulants: RR, 1.24; 95% CI, 0.84-1.83l nonstimulants: (RR, 1.22; 95% CI, 0.25-5.97).

They also found no statistically significant associations found for specific cardiovascular outcomes in relation 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).

Finally, the investigators did not find any associations with any cardiovascular disease in female patients (RR, 1.88; 95% CI, 0.43-8.24) or in individuals with preexisting cardiovascular disease (RR, 1.31; 95% CI, 0.80-2.16).

“This meta-analysis suggests no statistically significant association between ADHD medications and the risk of [cardiovascular disease] across age groups, although a modest risk increase could not be ruled out, especially for the risk of cardiac arrest or tachyarrhythmias,” the authors wrote. “Further investigation is warranted for the cardiovascular risk in female patients and patients with preexisting [cardiovascular disease] as well as long-term risks associated with ADHD medication use.”

The study, “Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity Disorder A Systematic Review and Meta-analysis,” was published online in Jama Network Open.