Association of ADHD medications with the risk of cardiovascular diseases: a meta-analysis
Hui Liu1, Wenjing Feng2, Dongfeng Zhang3
1Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, No. 38 Dengzhou Road, Shibei District, Qingdao, 266021, Shandong Province, China.
Insights
This meta-analysis found ADHD medications may be associated with a slightly increased risk of sudden death/arrhythmia. However, cohort studies indicated no significant correlation between ADHD medications and major cardiovascular events or all-cause death.
Area of Science:
- Cardiovascular Health
- Pharmacology
- Neuroscience
Background:
- Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder.
- ADHD medications are widely prescribed, raising questions about their long-term cardiovascular safety.
- Previous studies have yielded conflicting results regarding the association between ADHD medications and adverse cardiovascular events.
Purpose of the Study:
- To evaluate the association between Attention deficit hyperactivity disorder (ADHD) medications and the risk of sudden death/arrhythmia, stroke, myocardial infarction, and all-cause death.
- To synthesize evidence from observational studies using meta-analysis techniques.
- To investigate potential risk factors through subgroup analyses.
Main Methods:
- A comprehensive literature search was conducted in PubMed, Web of Science, and China National Knowledge Infrastructure from 1950 to May 2018.
- Observational studies reporting relative risks (RRs) and 95% confidence intervals (CIs) for ADHD medication exposure and cardiovascular outcomes were included.
- Pooled RRs were estimated using a random-effects model, with subgroup analyses performed to explore heterogeneity.
Main Results:
- The meta-analysis included ten studies with 4,221,929 participants.
- A pooled RR of 1.39 (1.06, 1.83) for sudden death/arrhythmia was observed for ADHD medications.
- Pooled RRs for stroke, myocardial infarction, and all-cause death were 1.00 (0.74, 1.35), 0.91 (0.79, 1.05), and 0.89 (0.54, 1.45), respectively.
- For methylphenidate, the pooled RR for sudden death/arrhythmia was 1.46 (1.03, 2.07).
- Cohort studies specifically showed no significant correlation between ADHD medications and sudden death/arrhythmia, stroke, myocardial infarction, or all-cause death.
Conclusions:
- While the overall meta-analysis suggested a potential increased risk of sudden death/arrhythmia with ADHD medications, results from cohort studies did not support this association.
- Some confidence intervals indicated a possibility of modest elevated risks, warranting careful consideration.
- Further research, particularly well-designed cohort studies, is needed to definitively assess the cardiovascular safety of ADHD medications.
Abstract:
This meta-analysis was conducted to evaluate the association between Attention deficit hyperactivity disorder (ADHD) medications and risk of sudden death/arrhythmia, stroke, myocardial infarction as well as all-cause death. We searched PubMed, Web of Science and China National Knowledge Infrastructure from 1950 to May 2018. All observational studies that the exposure of interest was ADHD medications, the outcome of interest was sudden death/arrhythmia, stroke, myocardial infarction as well as all-cause death, and the study reported relative risks (RRs) with 95% confidence intervals (95% CIs) were included. Pooled RRs were estimated by random-effects model. Subgroup analyses were conducted to examine the effects of study design, population, Country, follow-up duration, female proportion, covariates adjustment on the risk of sudden death/arrhythmia. Eight articles with ten studies (4,221,929 participants) were included in this meta-analysis about the association between ADHD medications and risk of sudden death/arrhythmia. The pooled RRs with 95% CIs of sudden death/arrhythmia for ADHD medications were 1.39 (1.06, 1.83). The result of the cohort study was 1.24 (0.84, 1.83). The pooled RRs between ADHD medications and stroke, myocardial infarction, all-cause death were 1.00 (0.74, 1.35), 0.91 (0.79, 1.05), 0.89 (0.54, 1.45), respectively. As for methylphenidate, the pooled RRs between methylphenidate and sudden death/arrhythmia, stroke, myocardial infarction, all-cause death were 1.46 (1.03, 2.07), 0.92 (0.70, 1.21), 0.97 (0.77, 1.23), 1.00 (0.49, 2.04), respectively. Based on the results of cohort studies, there was no correlation between ADHD medications and sudden death/arrhythmia, stroke, myocardial infarction and all-cause death. However, some of the confidence intervals do not exclude modest elevated risks, e.g., for sudden death/arrhythmia.
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