How Long-Term ADHD Med Use May Raise Cardiovascular Risk

While a year-long Adderall shortage persists, turning routine ADHD treatment into a guessing game, patients received more bad news late last month.

JAMA Psychiatry published the results of a new case control study that suggests long-term ADHD medication use could lead to a greater risk of cardiovascular disease. 

“In this case-control study of 278,027 individuals in Sweden aged 6 to 64 years who had an incident ADHD diagnosis or ADHD medication dispensation, longer cumulative duration of ADHD medication use was associated with an increased risk of CVD, particularly hypertension and arterial disease, compared with nonuse,” the study showed.

Since most randomized clinical trials (RCTs) cover much smaller sample windows, the researchers sought to take a longer view. As a result, this long-term study ran more than 13 years, from Jan. 1, 2007, and Dec. 31, 2020.

While ADHD diagnoses have climbed steadily over the last several years, reaching 10 percent of U.S. children and 8 percent of U.S. adults, this new research might require a clinical reassessment of the risks involved in existing treatment plans. This is increasingly critical since “a substantial proportion of young individuals with ADHD continues to have impairing symptoms in adulthood, necessitating prolonged use of ADHD medication,” the study read. “Notably, studies have indicated a rising trend in the long-term use of ADHD medications, with approximately half of individuals using ADHD medication for over 5 years.”

Key Study Details

The study considered all ADHD medications approved in Sweden during the study period, including:

• Stimulants (methylphenidate, amphetamine, dexamphetamine, and lisdexamfetamine), and
• Nonstimulants (atomoxetine and guanfacine).

The researchers also looked at the associations between ADHD medication use and specific CVDs, “including arrhythmias, arterial disease, cerebrovascular disease, heart failure, hypertension, ischemic heart disease, and thromboembolic disease,” while also taking into account gender-specific associations.

Significant Study Results

In short, this extended, nested case-control study found an increased risk of incident CVD associated with long-term ADHD medication use. It also found that the risk escalated with longer medication use. The researchers noted a statistically greater incidence of hypertension and arterial disease and a higher rate of adverse effects tied to stimulant treatment.

“We found individuals with long-term ADHD medication use had an increased risk of incident CVD in a dose-response manner in the first 3 years of cumulative ADHD medication use. To our knowledge, few previous studies have investigated the association between long-term ADHD medication use and the risk of CVD with follow-up of more than two years,” the study reported.

But there is a silver lining: The numbers also reveal that the CVD dangers – 23 percent higher for more than five years of ADHD treatment – is lower than previously reported. The study’s authors also observed that adverse effects leveled off after the first several years of treatment and persisted throughout the 14-year follow-up period.

More ADHD Drug Research Needed

Academics and practitioners alike have long acknowledged the tie between ADHD medication use and higher blood pressure. This latest study not only reinforces that, it highlighted an association with arterial disease as well. Consequently, the study’s authors assert the need for more research to more effectively evaluate the impact of ADHD medications on patients’ lipid profiles.

“We did not observe any association between ADHD medication use and the risk of arrhythmias,” they wrote. “A recent systematic review of observational studies of ADHD medication use reported an elevated risk of arrhythmias, but the finding was not statistically significant. A review of RCTs also found that the use of stimulants was associated with an average increase in heart rate of 5.7 beats/min, but no evidence of prolonged QT interval or tachycardia was found based on electrocardiograms.”

Additionally, this study showed that “increasing cumulative durations of methylphenidate and lisdexamfetamine use were associated with incident CVD, while the associations for atomoxetine were statistically significant only for the first year of use.”

The researchers also discovered no discernable difference between men and women, contradicting earlier studies that suggest a higher incidence of CVDs in women. But they’re also quick to point out that further research would elucidate the gender-specific differences that might exist.

Further Reading:

Adderall Shortage Will Last Until At Least Spring

Relationship of Premenstrual Dysphoric Disorder With Bipolar Disorder

Undiagnosed Adult ADHD Detected During the COVID-19 Pandemic