Do medications for the treatment of attention-deficit/hyperactivity disorder increase the risk of serious cardiovascular disease events in young adults and middle-aged adults?
Previous studies from JAMA and The New England Journal of Medicine found no evidence that ADHD medications increase the risk of serious cardiovascular events in young and middle-aged adults. This updated systematic review confirms this finding. 1a-
These investigators thoroughly searched multiple databases, including MEDLINE, Embase, PsycINFO, and the Web of Science, as well as reference lists of relevant publications, up to May 2022 for observational studies that investigated associations between attention-deficit/hyperactivity disorder (ADHD) medication use and the subsequent risk of any cardiovascular disease (CVD). Two investigators independently evaluated individual studies for eligibility criteria and risk of bias using the Good Research for Comparative Effectiveness (GRACE) checklist. Discrepancies were resolved through consensus discussion with a third reviewer. A total of 19 studies (N = 3,931,532 participants) met eligibility criteria. Study samples included children, adolescents, and adults with an average follow-up time ranging from 0.25 to 9.5 years. Overall risk of bias of the included studies was low to moderate. ADHD medication use was not significantly associated with the risk of any CVD across any age groups. In addition, no subgroup significance occurred for stimulant versus nonstimulant medications, male versus female gender, or in individuals with or without a history of CVD. Heterogeneity between studies was significant, but no evidence of publication bias was detected.
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Professor of Family Medicine, UNC Chapel Hill