ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults

Study Questions:

What is the association between the use of attention deficit–hyperactivity disorder (ADHD) drugs and the risk of serious cardiovascular events in children and young adults?

Methods:

The investigators conducted a retrospective cohort study with automated data from four health plans (Tennessee Medicaid, Washington State Medicaid, Kaiser Permanente California, and Optum Insight Epidemiology), with 1,200,438 children and young adults between the ages of 2 and 24 years and 2,579,104 person-years of follow-up, including 373,667 person-years of current use of ADHD drugs. They identified serious cardiovascular events (sudden cardiac death, acute myocardial infarction, and stroke) from health plan data and vital records, with endpoints validated by medical-record review. The authors estimated the relative risk of endpoints among current users, as compared with nonusers, with hazard ratios from Cox regression models.

Results:

Cohort members had 81 serious cardiovascular events (3.1 per 100,000 person-years). Current users of ADHD drugs were not at increased risk for serious cardiovascular events (adjusted hazard ratio, 0.75; 95% confidence interval [CI], 0.31-1.85). Risk was not increased for any of the individual endpoints, or for current users as compared with former users (adjusted hazard ratio, 0.70; 95% CI, 0.29-1.72). Alternative analyses addressing several study assumptions also showed no significant association between the use of an ADHD drug and the risk of a study endpoint.

Conclusions:

The authors concluded that this large study showed no evidence that current use of an ADHD drug was associated with an increased risk of serious cardiovascular events.

Perspective:

This study assessed the cardiovascular safety of ADHD drugs in more than 1.2 million children and young adults from four geographically diverse health plans, with more than 2.5 million person-years of follow-up. The point estimate of the relative risk provided no evidence that the use of ADHD drugs increased the risk of serious cardiovascular events. Although the upper limit of the 95% CI suggested that a doubling in the risk could not be ruled out, the absolute magnitude of any increased risk would be low. Overall, the results are consistent with the results of several prior reports, and provide further reassurance about the cardiovascular safety of these agents.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, CHD & Pediatrics and Quality Improvement

Keywords: Child, Attention Deficit Disorder with Hyperactivity, Washington, Incidence, Myocardial Infarction, Follow-Up Studies, Death, California, Cardiovascular Diseases, Risk Factors, Tennessee, United States


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