Cardiovascular Risk of ADHD Treatment

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioral disorder and treatment can ameliorate symptoms and improve quality of life. But most ADHD treatments can increase heart rate and blood pressure by stimulating the sympathetic nervous system and potentially increase cardiovascular risk. A recent study published in the Journal of American College of Cardiology checked association between long-term use of medications for ADHD and cardiovascular outcomes [1]. Adult patients started on ADHD treatment for the first time between 1998 and 2020 were identified using nation wide registers from Denmark. Outcomes evaluated in the study were acute coronary syndromes, stroke, heart failure and a composite of these. Over seventy three thousand adult first time users were identified. Those who discontinued treatment within 180 days were categorized as prior users and was about 36% of the initial number. Persons still on treatment were more likely to be concomitantly treated with non steroidal anti-inflammatory agents, antipsychotics, antidepressants and sedative hypnotics.

In the final analysis, associations between ADHD treatment and elevated 10-year risk of stroke, heart failure and composite cardiovascular outcome were found. A dose response relationship with higher dose was noted. Notably, there was no association with increased risk of acute coronary syndromes. Higher absolute risk of heart failure and stroke was noted in those on concomitant psychopharmaceutical and NSAID treatment. Ten year absolute risk was much higher in older age group. Relative risk of heart failure seemed to be most signifigantly influenced by increasing dosage and years of exposure. This is reasonable because the increase in number of years with increased sympathetic tone elevating heart rate and blood pressure could lead to heart failure. With all potential limitations of a register analysis, these data should be taken as hypothesis generating and followed up with randomized controlled clinical trials.

Reference

1. Holt A, Strange JE, Rasmussen PV, Nouhravesh N, Nielsen SK, Sindet-Pedersen C, Fosbøl EL, Køber L, Torp-Pedersen C, Gislason GH, McGettigan P, Schou M, Lamberts M. Long-Term Cardiovascular Risk Associated With Treatment of Attention-Deficit/Hyperactivity Disorder in Adults. J Am Coll Cardiol. 2024 May 14;83(19):1870-1882. doi: 10.1016/j.jacc.2024.03.375. PMID: 38719367.