Long-Term ADHD Medication Use Can Increase Cardiovascular Disease Risk

Results from a large study carried out in Sweden show that long-term use of attention-deficit/hyperactivity disorder (ADHD) medication can increase cardiovascular disease (CVD) risk.

Zheng Chang, a group leader at the Karolinska Institutet in Stockholm, and colleagues found that for every year of ADHD medication use CVD risk increased by four percent.

ADHD is a common disorder that is characterized by differing combinations of inattentiveness, impulsivity, and hyperactivity. Pharmacological therapy with stimulants and nonstimulants is recommended as a treatment in many countries including the U.S.

“The use of ADHD medication has increased greatly in both children and adults during the past decades,” write the authors in JAMA Psychiatry.

“Although the effectiveness of ADHD medications has been demonstrated in randomized clinical trials and other studies, concerns remain regarding their potential cardiovascular safety.”

The current study sought to investigate CVD risk in people with ADHD. It included 278,027 individuals with ADHD aged six to 64 years who had a diagnosis of ADHD or were given an ADHD medication prescription between 2007 and 2020.

Of this group, 10,388 individuals with active CVD were identified and were matched with 51,672 control participants without CVD. The follow-up period for the group ranged between 1.9 and 6.8 years.

The researchers found that cumulative use of ADHD medications was linked to increased risk for developing CVD, particularly arterial disease and high blood pressure, compared with nonuse. For example, up to one year of medication use had little effect, but one year or more increased relative risk by 9%, two or more by 15%, and three or more by 27%.

After adjusting for potential confounding factors, the team calculated that each additional year of ADHD medication use increased the risk of CVD by 4% on average with a larger risk increase in the first three years of cumulative use.

Notably, this pattern seemed to remain the same regardless of age, as it was similar in those under 25 years to that in those older than 25 years.

“These findings highlight the importance of carefully weighing potential benefits and risks when making treatment decisions on long-term ADHD medication use,” write the authors.

“Clinicians should be vigilant in monitoring patients, particularly among those receiving higher doses, and consistently assess signs and symptoms of CVD throughout the course of treatment. Monitoring becomes even more crucial considering the increasing number of individuals engaging in long-term use of ADHD medication.”