New Finding: ADHD Medication Not Associated with Cardiovascular Risk at Any Age
ADHD medication is not associated with hypertension, heart failure, or other cardiovascular disease in patients of any age, according to a new meta-analysis that could revolutionize treatment for middle-aged and older adults with attention deficit disorder.
November 28, 2022
ADHD medications — both stimulants and non-stimulants — do not place patients of any age at greater risk for cardiovascular events such as heart failure and hypertension. This groundbreaking finding comes from a new meta-analysis of 19 observational studies, including 3.9 million participants, that found no statistically significant association between ADHD medications and cardiovascular disease (CVD), even among middle-aged and older adults.1
The analysis, published November 23 in JAMA Network Open, is the most comprehensive systematic review and meta-analysis of longitudinal observational studies to date on the association between ADHD medication use and the risk of CVD. It included patients from the United States, South Korea, Canada, Denmark, Spain, and Hong Kong. It found no associations between ADHD medication use and a higher incidence of CVD, however, it did recommend further research on the risk of cardiac arrest and tachyarrhythmias among female patients and patients with pre-existing CVD.
“The results of this meta-analysis suggested no statistically significant association between ADHD medication use and the risk of any cardiovascular events across age groups, although a modest risk increase could not be excluded, especially for the risk of cardiac arrest or tachyarrhythmias,” the study authors wrote. “Therefore, clinicians should discuss with their patients and families the possible cardiovascular risk of ADHD medication in light of the latest evidence, and they should rigorously follow clinical guidelines that suggest monitoring of blood pressure and heart rate at baseline and each medication review.”
Clinicians should not outright disallow ADHD medication for adult patients, according to the JAMA findings. This represents a stark change to the status quo for many medical practitioners who have ruled out stimulants and non-stimulants due to fear of cardiovascular side effects, said William Dodson, M.D.
“Since I have been in the ADHD field, I’ve had to battle the false belief perpetuated by the FDA that the stimulant medications were somehow cardiotoxic despite not having the slightest evidence that they were toxic at all,” said Dodson, who led an ADDitude webinar in April 2022 titled, “Why Adults with ADHD Abandon Medication.” “The only effect that these medications have on the cardiovascular system is that if the dose is too high or you’ve added a stimulant on top of a finely tuned dose, it’s going to increase the blood pressure and increase the heart rate. That’s it.”
In recent correspondence with ADDitude, Dodson called the JAMA meta-analysis “the most important article in the last decade” in ADHD medicine and heralded it as a “turning point,” particularly for older adults who have been unable to treat their ADHD with medication due to fears of cardiovascular side effects.
“This is probably the single biggest false belief about ADHD medications… Taking stimulant medications does not increase your cardiovascular risk at all, zero, nothing,” Dodson said. “Cardiologists know that these medications are not dangerous and that there is lots of research to support that.”
However, in a JAMA editorial published alongside the recent finding, Roy C. Ziegelstein, M.D., advised clinicians to proceed with caution. He expressed the need for further research into elderly patients, as well as women and individuals with pre-existing CVA. He also sought data broken out by race and ethnicity, and comorbidities.
“Although the study by Zhang et al. is reassuring in many ways,” wrote Ziegelstein, a cardiovascular disease expert at Johns Hopkins University School of Medicine, “health care professionals must carefully weigh these factors when prescribing ADHD medications, especially to older adults, individuals with established CVD, and those with other comorbidities that increase CVD risk.”
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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