Recent research has unveiled a concerning association between the prolonged use of medication for attention deficit-hyperactivity disorder (ADHD) and an elevated risk of cardiovascular diseases in both adults and children.
The study, published on November 22 in JAMA Psychiatry, establishes a link between the use of ADHD medications and a heightened susceptibility to high blood pressure and arterial disease.
Arterial disease, also known as artery disease, encompasses conditions affecting the blood vessels that impact the body’s arteries.
Coauthor Le Zhang, PhD, a postdoctoral researcher at the Karolinska Institutet in Stockholm, emphasizes the importance of medical professional being vigilant in monitoring signs and symptoms of heart diseases, particularly in individuals taking higher doses of ADHD medications.
Dr. David Goodman, an assistant professor in the department of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine in Baltimore, provides a balanced perspective on the identified risks.
He suggests that while the risks are informative, they should not be exaggerated or instill fear in patients, leading them to avoid taking their ADHD medications as prescribed.
Dr. Goodman, who wasn’t involved in the study, says, “The message here is that patients and prescribers need to be aware of the risk so that it can be monitored and managed.”
More Adults Are Being Diagnosed with ADHD
The prevalence of ADHD diagnoses has been on the rise, with approximately 1 in 10 U.S. children diagnosed, according to the Centers for Disease Control and Prevention. Additionally, the incidence of adults with ADHD has significantly increased over the past decade, as reported in a November 2019 study in JAMA Network Open, which found a 43 percent rise in the rate of newly diagnosed adults in the previous decade.
Stimulant medications, including methylphenidate and amphetamines such as Ritalin or Adderall, are the primary first-line treatment for ADHD in both school-aged children and adults.
Cardiovascular Risk May Increase with Stimulants
The study delves into the potential cardiovascular risks associated with these stimulant medications, shedding light on the intricate relationship between ADHD treatment and its impact on the cardiovascular system.
ADHD medications work by stimulating the sympathetic nervous system, responsible for controlling heart rate and breathing. Samuele Cortese, MD, PhD, a professor of child and adolescent psychiatry at the University of Southampton in England and a coauthor of an editorial accompanying the study, explains that from a biological standpoint, these medications may increase heart rate and blood pressure. Prolonged exposure to such increases raises concerns about potential cardiovascular issues and an elevated risk of heart attacks.
Elevated Risk Associated with Higher Doses of ADHD Medications
The extensive study, involving over 275,000 participants aged 6 to 64, diagnosed with ADHD or receiving ADHD medication between January 1, 2007, and December 31, 2020, used comprehensive data from a Swedish nationwide database.
The participants were followed for up to 14 years, revealing key findings:
- Individuals taking ADHD medications had an increased risk of high blood pressure and arterial disease, with the risk intensifying over time.
- Each additional year of taking ADHD medication raised the risk of heart disease by an average of 4 percent, with more significant increases, around 8 percent, during the initial three years of treatment.
- The risk was consistent across children and adults, as well as both men and women.
- Specific medications, such as methylphenidate and lisdexamphetamine (Vyvanse), posed a long-term cardiovascular risk when used for three years or more. However, for atomoxetine (Strattera), a non-stimulant, the risk increased only during the first year.
- The risk elevation occurred only above certain average doses, emphasizing the importance of monitoring dosage levels.
Dr. Cortese says, “This is a very important study in the field of ADHD, as it provides data on the long-term cardiovascular effects of the pharmacological treatment for ADHD, with some patients followed for 14 years.”
While earlier research commonly noted this impact within the initial two years of initiating treatment, there was limited evidence, prior to this study, regarding the cardiovascular effects of long-term use, he adds.
No Elevated Risk Identified for Events Such as Stroke or Heart Attack
“Although the elevated risks in blood pressure and arterial disease were observed, it’s important to point out that there was no significant risk for arrhythmias, heart failure, ischemic heart disease, thromboembolic disease, and cerebrovascular disease, and no significant risk below certain dosages of medication,” says Dr. Cortese.
Notably, the study did not find an increased risk for events like heart attack, stroke, and arrhythmias, suggesting that the risk of sudden death events associated with taking stimulants is extraordinary rare, especially without preexisting risks.
“So, although it’s informative to understand the risks that were observed here, it shouldn’t be alarming to people who need to take ADHD medication to manage their condition. Patients shouldn’t see the headline and think, ‘Oh my gosh, I can’t take my medicine because I’m going to die of a heart attack.’ That’s actually not the case,” he says.
The Benefits of ADHD Meds Usually Outweigh the Risks
“As with any type of medications, potential risks should be balanced against established benefits,” says Dr. Cortese.
When individuals with ADHD adhere to their prescribed medication regimen (using methylphenidate as an illustrative example), they encounter notably fewer unintentional physical injuries, motor vehicle crashes, substance use disorders, and criminal acts. Additionally, there is an observable enhancement in academic functioning during periods of medication usage compared to intervals when they are not taking it, according to Dr. Cortese.
Both Dr. Cortese and Dr. Goodman recommend monitoring blood pressure and pulse. “The best way is to check it regularly at home with an arm cuff — you get more accurate readings that way,” says Goodman. Record the readings so that you will be able to track changes, he adds.
Should you observe a rise in either metric, it is advisable to consult with your healthcare provider. They may consider altering your medication or prescribing a specific medication to assist in controlling elevated blood pressure, as recommended by Dr. Goodman.
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