martes, 20 de diciembre de 2011

ADHD Medications and Risk of Serious Coronary Heart Disease in Young and Middle-Aged Adults

ADHD Medications Found Not to Increase Heart Attack, Stroke Risks in Adults

Medications used to treat attention-deficit hyperactivity disorder (ADHD) in adults are not linked to increased risk of heart attack, sudden cardiac death or stroke, according to new research from AHRQ’s Effective Health Care Program. The research results were published in the December 12 issue of the Journal of the American Medical Association. Researchers found no evidence of an increased risk of serious cardiac outcomes associated with current use compared to non-use or former use of ADHD medications. Researchers also found little support for an increased risk for any specific medication or with longer duration of current use. The study follows another recent AHRQ-funded study, published in the November 17 issue of the New England Journal of Medicine that showed no increased risk of serious cardiac outcomes in children and young adults ages 2 to 24 (see item below). Both studies resulted from research collaboration between AHRQ and the U.S. Food and Drug Administration, and were conducted by Vanderbilt University and the HMO Research Network DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) centers. Select to access the report and select to access the abstract on PubMed.®

Research Report - Final – Dec. 12, 2011

ADHD Medications and Risk of Serious Coronary Heart Disease in Young and Middle-Aged Adults

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ADHD Medications and Risk of Serious Coronary Heart Disease in Young and Middle-Aged Adults - Research Report - Final | AHRQ Effective Health Care Program

JAMA. 2011 Dec 12. [Epub ahead of print]

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

Source

Kaiser Permanente Northern California, Oakland (Drs Habel, Go, Sidney, Nguyen-Huynh, and Selby, Mr Fireman, and Mss Achacoso and Uratsu); Department of Pediatrics (Dr Cooper), Division of Pharmacoepidemiology, Department of Preventive Medicine (Drs Cooper and Ray), and Department of Biostatistics (Dr Arbogast), Vanderbilt University, Nashville, Tennessee; Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, and Department of Pediatrics, Boston University School of Medicine, Boston (Dr Sox); OptumInsight Epidemiology, Waltham, Massachusetts (Dr Chan); Pharmacy Analytical Service, Kaiser Permanente Southern California, Downy (Dr Cheetham); Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena (Drs Cheetham and Quinn); Group Health Research Institute, Seattle, Washington (Drs Dublin and Boudreau); Departments of Epidemiology (Dr Dublin) and Pharmacy (Dr Boudreau), University of Washington, Seattle; Meyers Primary Care Institute, Worcester, Massachusetts (Dr Andrade); HealthPartners Research Foundation, Bloomington, Minnesota (Dr Pawloski); Institute for Health Research, Kaiser Permanente Colorado, and School of Pharmacy, University of Colorado at Denver (Dr Raebel); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Dr Smith); and Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco (Dr Sidney).

Abstract

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. There were 107 322 person-years of current use (median, 0.33 years), with a crude incidence per 1000 person-years of 1.34 (95% CI, 1.14-1.57) for MI, 0.30 (95% CI, 0.20-0.42) for SCD, and 0.56 (95% CI, 0.43-0.72) for stroke. The multivariable-adjusted rate ratio (RR) of serious cardiovascular events for current use vs nonuse of ADHD medications was 0.83 (95% CI, 0.72-0.96). Among new users of ADHD medications, the adjusted RR was 0.77 (95% CI, 0.63-0.94). The adjusted RR for current use vs remote use was 1.03 (95% CI, 0.86-1.24); for new use vs remote use, the adjusted RR was 1.02 (95% CI, 0.82-1.28); the upper limit of 1.28 corresponds to an additional 0.19 events per 1000 person-years at ages 25-44 years and 0.77 events per 1000 person-years at ages 45-64 years.Conclusions Among young and middle-aged adults, current or new use of ADHD medications, compared with nonuse or remote use, was not associated with an increased risk of serious cardiovascular events. Apparent protective associations likely represent healthy-user bias.