Drugs against attention deficit hyperactivity disorder (ADHD) increase the risk of cardiovascular disease, according to the largest study on the long-term effects of this type of medication. The results show that only a minority of people who take ADHD medication develop cardiovascular problems. The authors of the study, from the Karolinska Institute in Stockholm (Sweden), defend pharmacological treatment against ADHD but advocate individualized monitoring of those affected to modify the medication in cases where it is appropriate.
Researchers have analyzed data from the 278,020 people diagnosed with ADHD in Sweden, or who have been prescribed ADHD drugs without being diagnosed, from the beginning of 2007 to the end of 2020. Those affected have been followed for a median of more than four years, with some cases that have reached up to 14 years of follow-up. This has made it possible to assess long-term effects of the medication that could not be detected in clinical trials, which for this type of drugs do not offer data beyond two years.
According to results presented today in the journal JAMA Psychiatry, people who take ADHD medication for more than three years have a 72% higher risk of developing hypertension than people who do not take medication. The risk of arterial diseases also increases by 65% with more than three years of medication.
No significant increase in the risk of myocardial infarction, stroke, or heart failure has been detected. However, given that hypertension is the number one cause of cardiovascular mortality, and that its effects usually take decades to manifest, it cannot be ruled out that a greater risk of heart attack or stroke would have emerged with longer-term follow-up of the population. studied.
Even so, only 4% of the people analyzed have been diagnosed with cardiovascular diseases, which indicates that the medication is safe for the vast majority of those affected by ADHD.
The increased risk of hypertension and arterial disease affects men and women equally, and can affect both adults and minors, according to data from Swedish registries.
“In the subgroup of children and young people, we have identified cases of cardiovascular disease between 6 and 24 years of age,” reports epidemiologist Le Zhang, first author of the research, by email. The cases “include hypertension, arrhythmias and thromboembolism.”
The risk increases progressively during the first three years of medication and then tends to stabilize, without increasing much further. Therefore, if a person has not had complications in the first three years, it is unlikely that he will have them later.
By type of medication, stimulants (such as methylphenidate and some amphetamines, which are the most prescribed) have a higher risk than non-stimulants (such as atomoxetine or guanfacine). The higher the dose, the greater the increased risk.
Pharmacological treatments against ADHD are highly effective, recall Samuele Cortese and Cristiano Fava, from the universities of Southampton and Verona, respectively. As they write in a review article published in JAMA Psychiatry, “people with ADHD experience significantly fewer unintentional physical injuries, traffic accidents, addictions, and criminal acts, and have better academic functioning, during the periods in which they take [the medication], compared to periods when they do not take it.”
For this reason, the authors of the Swedish study advocate that these drugs continue to be used but that awareness be raised of their possible adverse effects on cardiovascular health. “Physicians should ensure that they monitor patients, particularly those receiving higher doses, and evaluate signs and symptoms of cardiovascular disease throughout treatment,” they state in the conclusions of their research.
In cases where an adverse effect of medication is detected, the European ADHD Guidelines Group recommends evaluating the change in treatment on a case-by-case basis, considering the benefits and risks for each patient. Options include reducing the dose, changing drugs, or stopping treatment until the detected problem is resolved.
