Long-Term Cardiovascular Risk Associated With Treatment of Attention-Deficit/Hyperactivity Disorder in Adults
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Long-Term Cardiovascular Risk Associated With Treatment of Attention-Deficit/Hyperactivity Disorder in Adults. / Holt, Anders; Strange, Jarl E.; Rasmussen, Peter Vibe; Nouhravesh, Nina; Nielsen, Sebastian Kinnberg; Sindet-Pedersen, Caroline; Fosbøl, Emil Loldrup; Køber, Lars; Torp-Pedersen, Christian; Gislason, Gunnar H.; McGettigan, Patricia; Schou, Morten; Lamberts, Morten.
In: Journal of the American College of Cardiology, Vol. 83, No. 19, 2024, p. 1870-1882.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Long-Term Cardiovascular Risk Associated With Treatment of Attention-Deficit/Hyperactivity Disorder in Adults
AU - Holt, Anders
AU - Strange, Jarl E.
AU - Rasmussen, Peter Vibe
AU - Nouhravesh, Nina
AU - Nielsen, Sebastian Kinnberg
AU - Sindet-Pedersen, Caroline
AU - Fosbøl, Emil Loldrup
AU - Køber, Lars
AU - Torp-Pedersen, Christian
AU - Gislason, Gunnar H.
AU - McGettigan, Patricia
AU - Schou, Morten
AU - Lamberts, Morten
N1 - Publisher Copyright: © 2024 American College of Cardiology Foundation
PY - 2024
Y1 - 2024
N2 - Background: Incrementing numbers of patients treated for attention-deficit/hyperactivity disorder (ADHD) call for scrutiny concerning long-term drug-safety. Objectives: This study aims to investigate associations between long-term use of ADHD treatment and cardiovascular outcomes. Methods: Using nationwide registers, adult patients first-time initiated on ADHD treatment between 1998 and 2020 were identified. Exposure groups were prior users, <1 defined daily dose (DDD) per day, ≥1 DDD per day determined at start of follow-up, and 1 year after patients’ first claimed prescription. Outcomes were acute coronary syndromes, stroke, heart failure, and a composite of the above. Results: At start of follow-up, 26,357, 31,211, and 15,696 individuals were correspondingly categorized as prior users (42% female, median age: 30 years [Q1-Q3: 23-41 years]), <1 DDD per day (47% female, median age: 31 years [Q1-Q3: 24-41 years]), and ≥1 DDD per day (47% female, median age: 33 years [Q1-Q3: 25–41 years]), respectively. Comparing ≥1 DDD per day with prior users, elevated standardized 10-year absolute risk of stroke (2.1% [95% CI: 1.8%-2.4%] vs 1.7% [95% CI: 1.5%-1.9%]), heart failure (1.2% [95% CI: 0.9%-1.4%] vs 0.7% [95% CI: 0.6%-0.8%]), and the composite outcome (3.9% [95% CI: 3.4%-4.3%] vs 3.0% [95% CI: 2.8 %-3.2%]) was found—with corresponding risk ratios of 1.2 (95% CI: 1.0-1.5), 1.7 (95% CI: 1.3-2.2), and 1.3 (95% CI: 1.1-1.5). No apparent associations were found for acute coronary syndrome (1.0% [95% CI: 0.8%-1.2%] vs 0.9% [95% CI: 0.8%-1.0%]). Conclusions: Possible associations between elevated long-term cardiovascular risk and increasing dosage of ADHD treatment use in a young patient group should warrant further investigation.
AB - Background: Incrementing numbers of patients treated for attention-deficit/hyperactivity disorder (ADHD) call for scrutiny concerning long-term drug-safety. Objectives: This study aims to investigate associations between long-term use of ADHD treatment and cardiovascular outcomes. Methods: Using nationwide registers, adult patients first-time initiated on ADHD treatment between 1998 and 2020 were identified. Exposure groups were prior users, <1 defined daily dose (DDD) per day, ≥1 DDD per day determined at start of follow-up, and 1 year after patients’ first claimed prescription. Outcomes were acute coronary syndromes, stroke, heart failure, and a composite of the above. Results: At start of follow-up, 26,357, 31,211, and 15,696 individuals were correspondingly categorized as prior users (42% female, median age: 30 years [Q1-Q3: 23-41 years]), <1 DDD per day (47% female, median age: 31 years [Q1-Q3: 24-41 years]), and ≥1 DDD per day (47% female, median age: 33 years [Q1-Q3: 25–41 years]), respectively. Comparing ≥1 DDD per day with prior users, elevated standardized 10-year absolute risk of stroke (2.1% [95% CI: 1.8%-2.4%] vs 1.7% [95% CI: 1.5%-1.9%]), heart failure (1.2% [95% CI: 0.9%-1.4%] vs 0.7% [95% CI: 0.6%-0.8%]), and the composite outcome (3.9% [95% CI: 3.4%-4.3%] vs 3.0% [95% CI: 2.8 %-3.2%]) was found—with corresponding risk ratios of 1.2 (95% CI: 1.0-1.5), 1.7 (95% CI: 1.3-2.2), and 1.3 (95% CI: 1.1-1.5). No apparent associations were found for acute coronary syndrome (1.0% [95% CI: 0.8%-1.2%] vs 0.9% [95% CI: 0.8%-1.0%]). Conclusions: Possible associations between elevated long-term cardiovascular risk and increasing dosage of ADHD treatment use in a young patient group should warrant further investigation.
KW - acute coronary syndrome
KW - attention-deficit/hyperactivity disorder
KW - attention-deficit/hyperactivity disorder treatment
KW - drug-safety
KW - heart failure
KW - pharmacoepidemiology
KW - stroke
U2 - 10.1016/j.jacc.2024.03.375
DO - 10.1016/j.jacc.2024.03.375
M3 - Journal article
AN - SCOPUS:85190981733
VL - 83
SP - 1870
EP - 1882
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 19
ER -
ID: 391213825