Cardiovascular Effects of ADHD Therapies: JACC Review Topic of the Week
Noel Torres-Acosta1, James H O'Keefe2, Caroline L O'Keefe3
1University of Missouri-Kansas City, Kansas City, Missouri.
Insights
ADHD stimulant prescriptions rose despite stable prevalence. Medications cause minor heart rate and blood pressure increases, with rare severe events. More research is needed on long-term safety and non-drug ADHD management.
Area of Science:
- Neuroscience
- Cardiovascular Medicine
- Pharmacology
Background:
- Attention-deficit/hyperactivity disorder (ADHD) prevalence remained stable over 30 years.
- Prescription rates for sympathomimetic stimulants for ADHD have significantly increased in the U.S.
Purpose of the Study:
- To systematically review ADHD medications, their cardiovascular toxicity, and non-drug management strategies.
- To evaluate the current evidence on the safety and efficacy of ADHD treatments.
Main Methods:
- Systematic review of PubMed articles.
- Screening for studies on ADHD medications, cardiovascular risks, and non-pharmacological interventions.
Main Results:
- ADHD stimulant medications are associated with modest increases in resting heart rate and blood pressure.
- Rare adverse cardiovascular events, including arrhythmia, cardiomyopathy, and sudden death, have been reported but causation is not implied.
- Limited randomized trial evidence exists for the long-term safety of ADHD medications, especially in adults.
Conclusions:
- Further research is crucial to fully understand the risks and benefits of ADHD stimulant medications.
- Non-pharmacological approaches, such as exercise and omega-3 fatty acids, warrant further investigation for managing ADHD symptoms.
Abstract:
Although the prevalence of attention-deficit/hyperactivity disorder (ADHD) has been stable over the past 3 decades, prescriptions of sympathomimetic stimulants have steadily increased in the United States. This study consisted of a systematic review of PubMed articles screened for ADHD medications and potential cardiovascular toxicity as well as nondrug strategies for managing ADHD. The cumulative body of data showed that ADHD medications cause modest elevations in resting heart rate and blood pressure. Other adverse effects reported with ADHD stimulants included arrhythmia, nonischemic cardiomyopathy, Takotsubo cardiomyopathy, and sudden death. However, such reports did not imply causation, and there was a paucity of randomized trial evidence addressing long-term safety of ADHD medications, particularly among adults. Further studies are essential to clarify the risks and benefits of ADHD stimulant medications and to explore nonpharmacological options, including regular exercise and omega-3 fatty acids, which could be helpful for improving ADHD symptoms.
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