ADHD medications linked to heart conditions

GPs should not be afraid to prescribe attention deficit hyperactivity disorder (ADHD) medications when needed, despite their potential to increase a patient’s risk of cardiovascular disease (CVD).
 
That is according to one GP expert, after an international 14-year study found people aged between six and 64 who were taking ADHD medications had a higher risk of hypertension and arterial disease.
 
‘There are some things which I expect, like hypertension because it is a stimulant agent … but I think the return on investment for a lot of these people is really important and they get a benefit from it,’ Associate Professor Ralph Audehm told newsGP.
 
‘We have to acknowledge first that this is not a made-up disease, this is very real, and then when I look at the data, in many ways, it’s actually quite reassuring because even though they say there’s an increase in CVD, it’s not particularly high.
 
‘It just helps us to have a chat with our patients when we’re initiating things like stimulants and also making sure that we do review their blood pressure on a regular basis.’
 
Published in JAMA Psychiatry, the case-control study followed 278,027 individuals in Sweden who had an ADHD diagnosis or ADHD medication dispensation.
 
Researchers found the longer a patient was cumulatively taking ADHD medication, the higher the risk of CVD, particularly hypertension and arterial disease.
 
‘Therefore, the potential risks and benefits of long-term ADHD medication use should be carefully weighed,’ the study concluded.
 
According to the researchers, across 14 years of follow-up, every year of use of ADHD medication was associated with a 4% increased risk of heart disease, with individuals having an increased risk in the first three years of medication usage.
 
They found the incidence rate of CVD was 7.34 per 1000 person-years, and that was irrelevant of age or gender.
 
‘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,’ researchers said.
 
‘Monitoring becomes even more crucial considering the increasing number of individuals engaging in long-term use of ADHD medication.’
 
But Associate Professor Audehm said the risk of CVD remains small, especially for younger patients.
 
‘If you think of the popularity of ADHD medication, in young people under 20, the risk of cardiovascular disease is incredibly low,’ he said.
 
‘In younger people, this is not really an issue, but as we get older and we develop other risk factors, then we may see a more sizable impact.’
 
ADHD diagnosis has skyrocketed in recent years, impacting around one in 20 Australians.
 
Earlier this month, a seven-month Senate committee inquiry into ADHD assessment and treatment recommended GPs play a greater role in diagnosis and management of the condition.
 
It also called for the Medicare Benefits Schedule (MBS) to be reviewed, the development of uniform prescribing rules, and a review of Pharmaceutical Benefits Scheme (PBS) diagnosis requirements for access to some medications.
 
Meanwhile, incidence of CVD is also on the rise, with around 571,000 Australians aged 18 and over currently living with heart disease, and ischaemic heart diseases remaining the country’s leading cause of death.
 
Associate Professor Audehm said the research is a reminder about the importance of monitoring any patient when they begin an ADHD treatment plan, but also the ‘lifechanging’ impacts of finding appropriate medicines.
 
‘The pendulum was far too on the side of under-recognition and under-diagnosis, now look at it, the pendulum may be swinging the other way, but we’ve still got a huge catch up to do for all those people who have really lived with this for years and decades,’ he said.
 
‘We already monitor their weight, we do monitor their blood pressure, and we do monitor other risk factors as well.
 
‘But as GPs we’re good at sitting down with the person in front of us and looking at the total being.’
 
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ADHD attention deficit hyperactivity disorder cardiovascular disease hypertension