New research shows that taking medication for attention deficit-hyperactivity disorder (ADHD) for a year or longer could increase the risk of cardiovascular diseases in adults and children. The findings, published on November 22 in JAMA Psychiatry, found a link between using ADHD medication and a higher risk of high blood pressure and arterial disease.
Arterial disease, sometimes called artery disease, involves the blood vessels that affect the arteries of the body.
Based on findings, doctors should be vigilant in monitoring signs and symptoms of heart diseases, particularly in people taking higher doses of ADHD medications, says coauthor Le Zhang, PhD, a postdoctoral researcher at the Karolinska Institutet in Stockholm.
The risks found here are informative, but shouldn’t be overblown or scare patients into not taking their ADHD medications as directed, says David Goodman, MD, an assistant professor in the department of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine in Baltimore. “The message here is that patients and prescribers need to be aware of the risk so that it can be monitored and managed,” says Dr. Goodman, who was not involved in the study.
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More Adults Being Diagnosed With ADHD
It’s estimated that about 1 in 10 U.S. children are diagnosed with ADHD, per the Centers for Disease Control and Prevention, and the prevalence of adults with the condition has risen significantly in the past decade. A study published in November 2019 in JAMA Network Open found a 43 percent increase in the rate of adults being newly diagnosed in the previous decade.
For both school-aged children and adults, stimulant medications are typically the first-line treatment for ADHD, with methylphenidate and amphetamines like Ritalin or Adderall being the most commonly used.
Why Stimulants Could Increase Cardiovascular Risk
ADHD medications stimulate the sympathetic nervous system, which controls heart rate and breathing. From a biological standpoint, it follows that ADHD treatment could increase heart rate and blood pressure, says Samuele Cortese, MD, PhD, a professor of child and adolescent psychiatry at the University of Southampton in England, and coauthor of an editorial that was published along with the study. The concern is that if these increases go on for a long time, it could result in cardiovascular issues and an elevated risk of heart attack, he says.
ADHD Meds Increased Risk, but Only at Higher Doses
The study included more than 275,000 participants between the ages of 6 and 64 who received either an ADHD diagnosis or ADHD medication between January 1, 2007, and December 31, 2020.
Researchers used data from a comprehensive Swedish nationwide database, incorporating both inpatient and outpatient diagnoses since 1973, along with information on prescribed medications from the Swedish Prescribed Drug Register.
Participants were followed for up to 14 years, with the average follow-up being a little over four years. Key findings include the following:
- People taking ADHD medications had a higher risk of high blood pressure and arterial disease, and the risk increased over time.
- Each additional year of taking ADHD medication raised the risk of heart disease by an average of 4 percent, with more substantial increases, around 8 percent, during the first three years of treatment.
- The risk was similar for both children and adults, and both men and women.
- When focusing on specific medications, the long-term cardiovascular risk was increased both for methylphenidate and lisdexamphetamine (Vyvanse) for three years or more. For people taking atomoxetine (Strattera), which is not a stimulant, the risk increased only during the first year.
- The risk elevation occurred only above certain average doses: 45 milligrams (mg) per day for methylphenidate and lisdexamphetamine, 22.5 mg per day for amphetamines, and 120 mg per day for atomoxetine — about 1.5 times the average daily dose.
“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,” says Dr. Cortese.
While previous studies have reported this effect generally within two years of starting treatment, there was not much evidence before this study on the cardiovascular effects for longer term use, he says.
Increased Risk for Events Like Stroke or Heart Attack Were Not Found
“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 Cortese.
The fact that no additional associated risk was found for factors like heart attack, stroke, and arrhythmias indicates that the risk of taking a stimulant and having a sudden death event is extraordinarily rare, especially if you don’t have preexisting risks for that, says Goodman.
“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.
Bottom Line: The Benefits of ADHD Meds Usually Outweigh the Risks
“As with any type of medications, potential risks should be balanced against established benefits,” says Cortese.
When individuals with ADHD take their medication as directed (he uses methylphenidate as an example) they experience significantly fewer unintentional physical injuries, motor vehicle crashes, substance use disorders, and criminal acts, as well as improved academic functioning, compared with periods when they are not taking it, says Cortese.
Both Cortese and 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.
If you notice an increase in either measure, check in with your healthcare provider. They might make changes in your medication or prescribe a medication to help manage your high blood pressure, says Goodman.