The researchers from the Karolinska Institutet in Sweden compared long-term users with nonuse in a study of 278,000 individuals in Sweden aged 6 to 64 years. All had an incident ADHD diagnosis or had been dispensed ADHD medication.
“These findings highlight the importance of carefully weighing potential benefits and risks when making treatment decisions about long-term ADHD medication use. Clinicians should regularly and consistently monitor cardiovascular signs and symptoms throughout the course of treatment,” the authors wrote in Journal of the American Medical Association Psychiatry.
The report noted that the use of ADHD medications has increased significantly over the past decades, but the potential risk of CVD has remained unclear.
The study team sought to assess the association between long-term use of ADHD medication and the risk of CVD. Study participants were diagnosed with the condition and/or were dispensed medication between January 1, 2007, and December 31, 2020, based on data from the Swedish National Inpatient Register and the Swedish Prescribed Drug Register.
Cases included patients with ADHD and an incident CVD diagnosis, including ischemic heart diseases, cerebrovascular diseases, hypertension, heart failure, arrhythmias, thromboembolic disease, arterial disease, and other forms of heart disease.
The 10,388 cases with CVD were matched with up to five controls without CVD based on age, sex, and calendar time and had the same duration of follow-up. They had a median age of 34.6 years and 59.2% were male. The cumulative duration of ADHD medication use was up to 14 years, with a median follow-up time of 4.1 years.
The results indicated that longer cumulative duration of ADHD medication use was associated with an increased risk of CVD compared with nonuse (0 to 1 year: adjusted odds ratio [AOR], 0.99; 95% CI, 0.93-1.06; 1 to 2 years: AOR, 1.09; 95% CI, 1.01-1.18; 2 to 3 years: AOR, 1.15; 95% CI, 1.05-1.25; 3 to 5 years: AOR, 1.27; 95% CI, 1.17-1.39; and >5 years: AOR, 1.23; 95% CI, 1.12-1.36).
Specifically, the researchers reported that longer, cumulative ADHD medication use was associated with an increased risk of hypertension (e.g., 3 to 5 years: AOR, 1.72; 95% CI, 1.51-1.97; and >5 years: AOR, 1.80; 95% CI, 1.55-2.08) and arterial disease (e.g., 3 to 5 years: AOR, 1.65; 95% CI, 1.11-2.45; and >5 years: AOR, 1.49; 95% CI, 0.96-2.32).
“Across the 14-year follow-up, each 1-year increase of ADHD medication use was associated with a 4% increased risk of CVD (AOR, 1.04 [95% CI, 1.03-1.05]), with a larger increase in risk in the first 3 years of cumulative use (AOR, 1.08 [95% CI, 1.04-1.11]) and stable risk over the remaining follow-up,” the authors pointed out. “Similar patterns were observed in children and youth (aged <25 years) and adults (aged 25 years).”
The researchers advised that their case-control study found that long-term exposure to ADHD medications was associated with an increased risk of CVDs, especially hypertension and arterial disease. “These findings highlight the importance of carefully weighing potential benefits and risks when making treatment decisions about long-term ADHD medication use,” they emphasized. “Clinicians should regularly and consistently monitor cardiovascular signs and symptoms throughout the course of treatment.”
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