“This Is a Turning Point in ADHD Research — and Treatment”

December 3, 2022

Over the years, persistent concerns by clinicians about the safety of ADHD medications have hampered treatment, particularly in middle-aged and older adults. The notion that ADHD stimulants were intrinsically toxic to the cardiovascular system, despite reliable evidence to the contrary, has now been debunked.

A new meta-analysis of studies from the last 15 years, involving more than 3.9 million participants, concluded that “ADHD medication use was not statistically significantly associated with the risk of any CVD (cardiovascular disease) among children and adolescents, young and middle-aged adults, older adults, or overall.” The analysis, published in JAMA Network Open, was the most comprehensive to date on the association between ADHD medication and CVD risk.¹

The study found:

• No elevated risk based on age, including, for the first time, the elderly.
• No significant difference in cardiovascular risk between males and females.
• No statistically significant risk in individuals with and without a history of CVD.
• No detectable risk from nonstimulant medication use.

[Download: ADHD Medications – Comparison Chart of Stimulants & Nonstimulants]

Moreover, there was no increased risk of cardiovascular disease, regardless of the type of CVD the patient had when starting the ADHD stimulant, or that developed while they were taking ADHD medications. These include:

• Heart attack (ischemia), coronary vascular disease, or cardiac arrest
• Stroke, cerebrovascular disease, or hemorrhage
• High blood pressure
• Arrhythmias and QTc prolongation
• Transient Ischemic Attack (TIA)
• Heart failure

Now that we know fears over an elevated risk of medication complications were unfounded, clinicians who either refused to consider prescribing stimulant medications or who, more commonly, discontinued prescribing the first-line stimulant medications when their patients reached older ages, can move forward by providing necessary and appropriate treatment.

This study is a turning point in ADHD research. From the beginning, false beliefs by some clinicians have harmed patients and minimized the seriousness of ADHD and the inherent dangers of having the condition. In November, a separate study found that ADHD was significantly more lethal than all cardiovascular causes and doubled the risk of death up to the age of 41.²

Although the analysis in JAMA was tremendously reassuring, especially for people with pre-existing cardiovascular disease, it must be emphasized that the findings are based on huge populations and may not fully apply to everyone. Consequently, every case must be evaluated on its own set of facts and testing. Treatment decisions must be made in consultation between the patient and their clinician, who can now rely on accurate data instead of baseless fears.

Cardiovascular Disease: Next Steps

• Free Download: The Ultimate Guide to ADHD Medication 
• Read: Cardiovascular Screening and ADHD Meds
• Read: FDA: ADHD Medications Pose No Heart Risk

William W. Dodson, M.D., LF-APA, is a board-certified adult psychiatrist and one of the first practitioners to specialize in adults with ADHD more than 25 years ago.

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Sources

¹Zhang L, Yao H, Li L, et al. (2022). Risk of Cardiovascular Diseases Associated with Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. JAMA Netw Open. https://doi.org/10.1001/jamanetworkopen.2022.43597

²Li, L., Chang, Z., Sun, J., Garcia-Argibay, M., Du Rietz, E., Dobrosavljevic, M., Brikell, I., Jernberg, T., Solmi, M., Cortese, S. and Larsson, H.  (2022). Attention-Deficit/Hyperactivity Disorder as a Risk Factor for Cardiovascular Diseases: A Nationwide Population-Based Cohort Study. World Psychiatry. 21: 452-459. https://doi.org/10.1002/wps.21020

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