Cited by 411Attention Deficit Hyperactivity DisorderPharmacovigilance and Adverse Drug ReactionsPharmacology and Obesity Treatment

ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults

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Cooper, William O., Habel, Laurel A., Sox, Colin M., Chan, K. Arnold, Arbogast, Patrick G., Cheetham, T. Craig, Murray, Katherine T., Quinn, Virginia P. +8 more·2011·New England Journal of Medicine

Abstract

BACKGROUND: Adverse-event reports from North America have raised concern that the use of drugs for attention deficit-hyperactivity disorder (ADHD) increases the risk of serious cardiovascular events. METHODS: We conducted a retrospective cohort study with automated data from four health plans (Tennessee Medicaid, Washington State Medicaid, Kaiser Permanente California, and OptumInsight Epidemiology), with 1,200,438 children and young adults between the ages of 2 and 24 years and 2,579,104 person-years of follow-up, including 373,667 person-years of current use of ADHD drugs. We identified serious cardiovascular events (sudden cardiac death, acute myocardial infarction, and stroke) from health-plan data and vital records, with end points validated by medical-record review. We estimated the relative risk of end points among current users, as compared with nonusers, with hazard ratios from Cox regression models. RESULTS: Cohort members had 81 serious cardiovascular events (3.1 per 100,000 person-years). Current users of ADHD drugs were not at increased risk for serious cardiovascular events (adjusted hazard ratio, 0.75; 95% confidence interval [CI], 0.31 to 1.85). Risk was not increased for any of the individual end points, or for current users as compared with former users (adjusted hazard ratio, 0.70; 95% CI, 0.29 to 1.72). Alternative analyses addressing several study assumptions also showed no significant association between the use of an ADHD drug and the risk of a study end point. CONCLUSIONS: This large study showed no evidence that current use of an ADHD drug was associated with an increased risk of serious cardiovascular events, although the upper limit of the 95% confidence interval indicated that a doubling of the risk could not be ruled out. However, the absolute magnitude of such an increased risk would be low. (Funded by the Agency for Healthcare Research and Quality and the Food and Drug Administration.).

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  • A study from the United States (n = 1,200,438) reported that ADHD drugs (methylphenidate, amphetamine and atomoxetine) did not increase the risk of serious cardiovascular events in children and young adults.

    “a study from the United States ( n = 1,200,438) reported that ADHD drugs (methylphenidate, amphetamine and atomoxetine) did not increase the risk of serious cardio vascular events in children and young adults 160 .”

    From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [160]

    The Results report a cohort of 1,200,438 children and youth; the Methods include methylphenidate, amphetamines, and atomoxetine among the medications studied. The Results found no statistically significant increase in serious cardiovascular events for current ADHD-medication users, but the Discussion cautions that the confidence interval could not rule out up to a two-fold increase. The claim omits that uncertainty and states the finding too definitively. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • The same was true for a subanalysis limited to methylphenidate, which was the only drug with sufficient data.

    “The same was true for a subanalysis limited to methylphenidate, which was the only drug with sufficient data.”

    From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [160]

  • Two large studies reported no significant increase in risk for cardiovascular events in current users of ADHD medications compared with nonusers.

    “However, these findings should be considered in light of data from 2 large studies that reported no significant increase in risk for cardiovascular events in current users of ADHD medications compared with nonusers (262, 263).”
  • Stimulant medications have not been shown to increase the risk of sudden death beyond that observed in children not receiving stimulants.

    “In fact, stimulant medications have not been shown to increase the risk of sudden death beyond that observed in children who are not receiving stimulants.114–118”

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Authors
Cooper, W. O., Habel, L. A., Sox, C. M., Chan, K. A., Arbogast, P. G., Cheetham, T. C., Murray, K. T., Quinn, V. P., Stein, C. M., Callahan, S. T., Fireman, B. H., Fish, F. A., Kirshner, H. S., O'Duffy, A., Connell, F. A., & Ray, W. A.
Affiliations
  • Vanderbilt University (US)
  • Harvard Pilgrim Health Care (US)
  • Boston University (US)
  • Kaiser Permanente (US)
  • University of Washington (US)
Venue
New England Journal of Medicine
Published
2011-11-17
Volume
365
Issue
20
Pages
1896-1904
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2106133175
Cited by
411
References
40
Citations by year
2026: 12 · 2025: 12 · 2024: 15 · 2023: 21 · 2022: 14 · 2021: 18 · 2020: 22 · 2019: 24 · 2018: 25 · 2017: 25 · 2016: 33 · 2015: 34 · 2014: 40 · 2013: 51 · 2012: 58
FWCI
34.34
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of Health and Human Services
  • Kaiser Permanente
  • Vanderbilt University
  • Washington State University
  • University of Washington
  • Agency for Healthcare Research and Quality
  • School of Medicine, Vanderbilt University
  • National Heart, Lung, and Blood Institute (R01HL096844)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
Keywords
attention deficit hyperactivity disorder, cardiovascular adverse events, sudden cardiac death, myocardial infarction, stroke, children and young adults, drug safety, Medicaid beneficiaries
MeSH terms
Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Cardiovascular Diseases, Child, Child, Preschool, Female, Humans, Male, Retrospective Studies, Risk, Cohort Studies, Young Adult

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