ADHD Medications and Risk of Serious Cardiovascular Events in Young and Middle-aged Adults

作者：Laurel A. Habel, William O. Cooper, Colin M. Sox, K. Arnold Chan, Bruce H. Fireman, Patrick G. Arbogast, T. Craig Cheetham, Virginia P. Quinn, Sascha Dublin, Denise M. Boudreau, Susan E. Andrade, Pamala A. Pawloski, Marsha A. Raebel, David H. Smith, Ninah S. Achacoso, Connie S. Uratsu, Alan S. Go, Steve Sidney, Mai N. Nguyen‐Huynh, Wayne A. Ray, Joe V. Selby · 发表于：JAMA · 年份：2011 · DOI：10.1001/jama.2011.1830 · 被引用次数：296 · 研究领域：Attention Deficit Hyperactivity Disorder、Neuroethics, Human Enhancement, Biomedical Innovations、Substance Abuse Treatment and Outcomes

CONTEXT: More than 1.5 million US adults use stimulants and other medications labeled for treatment of attention-deficit/hyperactivity disorder (ADHD). These agents can increase heart rate and blood pressure, raising concerns about their cardiovascular safety. OBJECTIVE: To examine whether current use of medications prescribed primarily to treat ADHD is associated with increased risk of serious cardiovascular events in young and middle-aged adults. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, population-based cohort study using electronic health care records from 4 study sites (OptumInsight Epidemiology, Tennessee Medicaid, Kaiser Permanente California, and the HMO Research Network), starting in 1986 at 1 site and ending in 2005 at all sites, with additional covariate assessment using 2007 survey data. Participants were adults aged 25 through 64 years with dispensed prescriptions for methylphenidate, amphetamine, or atomoxetine at baseline. Each medication user (n = 150,359) was matched to 2 nonusers on study site, birth year, sex, and calendar year (443,198 total users and nonusers). MAIN OUTCOME MEASURES: Serious cardiovascular events, including myocardial infarction (MI), sudden cardiac death (SCD), or stroke, with comparison between current or new users and remote users to account for potential healthy-user bias. RESULTS: During 806,182 person-years of follow-up (median, 1.3 years per person), 1357 cases of MI, 296 cases of SCD, and 575 cases of stroke occurred. Ther...