Stimulants and Pediatric Cardiovascular Risk

Area of Science:

• Pediatric Cardiology
• Psychopharmacology
• Public Health

Background:

• Stimulant medications are widely prescribed for youth.
• Concerns exist regarding potential cardiovascular (CV) risks associated with stimulant use in children and adolescents.
• This has prompted numerous population-based studies to investigate these risks.

Purpose of the Study:

• To systematically review and evaluate population-based studies on cardiovascular events in stimulant-treated youth.
• To summarize the findings regarding the association between stimulant use and CV events.
• To discuss clinical and policy implications for healthcare providers.

Main Methods:

• A comprehensive literature search was conducted using Medline and PsycINFO databases.
• Studies published between 1990 and 2015 were included, encompassing peer-reviewed and gray literature.
• Included study designs were population-based, such as case-control and retrospective cohort studies.

Main Results:

• One case-control study found a significant association between prior stimulant use and sudden unexplained death (OR=7.4).
• Most retrospective cohort studies did not find an association between current stimulant use and serious CV events (sudden death, MI, stroke).
• However, some studies indicated increased risks for CV-related emergency department visits and hospital services, particularly with concurrent use of stimulants and antipsychotics or antidepressants.

Conclusions:

• Population-based studies present mixed findings on the cardiovascular safety of stimulant treatment in youth.
• The review supports baseline and ongoing cardiac monitoring for stimulant users.
• Particular vigilance is advised for patients on concomitant regimens with antipsychotics and antidepressants to ensure a favorable benefit-risk profile.