Long-term ADHD Medication Use Associated with Increased Cardiovascular Disease
Research led by the Karolinska Institutet in Sweden has revealed a concerning association between long-term ADHD medication use and a heightened risk of cardiovascular disease (CVD). The study, published in JAMA Psychiatry, found specific links between different medications and dosages and the development of hypertension and arterial disease. Stimulant medications, in particular, were associated with a higher risk.
The research team conducted a case-control study, analyzing the CVD outcomes of 278,027 individuals aged 6 to 64 years who had been diagnosed with ADHD. The study identified 10,388 cases with CVD and matched them with 51,672 controls. The incidences of CVD were found to be significantly higher in the cases compared to the control group.
The cases were classified based on recorded diagnoses of various forms of CVD, including ischemic heart diseases, cerebrovascular diseases, hypertension, heart failure, arrhythmias, thromboembolic disease, arterial disease, and other heart conditions. Controls were selected to match the cases in terms of age, sex, and calendar time and were individuals without a CVD diagnosis when their matched cases received one.
Previous meta-analyses of randomized clinical trials have indicated that both stimulant and non-stimulant ADHD medications can increase heart rate and blood pressure. However, these trials were primarily short-term, highlighting the need for a longer-term follow-up study.
The recent investigation found that long-term use of the stimulant methylphenidate was associated with a 20% increased risk of CVD for users between 3 to 5 years, while users exceeding 5 years faced a 19% higher risk. Lisdexamfetamine, another stimulant medication, demonstrated an elevated risk of 23% for users between 2 to 3 years and 17% for those exceeding 3 years of use. Non-stimulant atomoxetine showed a significant association with CVD only during the first year of use, with a 7% increased risk.
ADHD is a prevalent psychiatric condition characterized by inattentiveness, impulsivity, and hyperactivity. Typically, pharmacological therapy involves the use of stimulant medications such as methylphenidate (Ritalin, Concerta) and dextroamphetamine-AMP (Adderall). While these stimulants can make most individuals feel jittery and amped-up, they have a calming effect on people with ADHD, enhancing their ability to focus.
Stimulants may seem counterintuitive as a treatment for individuals with hyperactive symptoms. However, they restore repressed catecholamine levels (neurotransmitters based on hormones) in ADHD patients by binding to presynaptic dopamine transporters or blocking reuptake mechanisms.
Atomoxetine (Strattera), on the other hand, is a non-stimulant drug that acts on the reuptake mechanism of norepinephrine. While it effectively manages symptoms in some patients, it is only successful for approximately 30% of individuals, compared to the roughly 70% success rate seen with stimulant medications.
Non-stimulant medications used in ADHD treatment can sometimes include formulations of tricyclic antidepressants. While effective in alleviating ADHD symptoms, these antidepressant options have been associated with heart arrhythmias. Additionally, off-target behavioral and psychological side effects have been reported with the use of any antidepressant.
The findings of this study raise concerns about the long-term use of ADHD medications, particularly stimulants, and their potential impact on cardiovascular health. While these medications can provide valuable benefits for individuals with ADHD, healthcare providers and patients should be aware of the associated risks and consider alternative treatment options when necessary.
In conclusion, the study conducted by the Karolinska Institutet highlights the increased risk of cardiovascular disease associated with long-term use of ADHD medications. The research findings emphasize the importance of monitoring patients on these medications and exploring alternative treatment approaches to mitigate potential cardiovascular risks. It is crucial for individuals with ADHD to have open discussions with their healthcare providers about the potential benefits and risks of medication use, ultimately making informed decisions regarding their treatment.
