Methylphenidate and Short-Term Cardiovascular Risk.

Journal: JAMA network open

Volume: 7

Issue: 3

Year of Publication: 2024

Affiliated Institutions:  School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden. Cluster of Excellence SimTech, University of Stuttgart, Stuttgart, Germany. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. School of Psychology, University of Southampton, Southampton, United Kingdom.

Abstract summary 

There are concerns about the safety of medications for treatment of attention-deficit/hyperactivity disorder (ADHD), with mixed evidence on possible cardiovascular risk.To assess whether short-term methylphenidate use is associated with risk of cardiovascular events.This retrospective, population-based cohort study was based on national Swedish registry data. Participants were individuals with ADHD aged 12 to 60 years with dispensed prescriptions of methylphenidate between January 1, 2007, and June 30, 2012. Each person receiving methylphenidate (n = 26 710) was matched on birth date, sex, and county to up to 10 nonusers without ADHD (n = 225 672). Statistical analyses were performed from September 13, 2022, to May 16, 2023.Rates of cardiovascular events, including ischemic heart disease, venous thromboembolism, heart failure, or tachyarrhythmias, 1 year before methylphenidate treatment and 6 months after treatment initiation were compared between individuals receiving methylphenidate and matched controls using a bayesian within-individual design. Analyses were stratified by history of cardiovascular events.The cohort included 252 382 individuals (15 442 [57.8% men]; median age, 20 (IQR, 15-31) years). The overall incidence of cardiovascular events was 1.51 per 10 000 person-weeks (95% highest density interval [HDI], 1.35-1.69) for individuals receiving methylphenidate and 0.77 (95% HDI, 0.73-0.82) for the matched controls. Individuals treated with methylphenidate had an 87% posterior probability of having a higher rate of cardiovascular events after treatment initiation (incidence rate ratio [IRR], 1.41; 95% HDI, 1.09-1.88) compared with matched controls (IRR, 1.18; 95% HDI, 1.02-1.37). The posterior probabilities were 70% for at least a 10% increased risk of cardiovascular events in individuals receiving methylphenidate vs 49% in matched controls. No difference was found in this risk between individuals with and without a history of cardiovascular disease (IRR, 1.11; 95% HDI, 0.58-2.13).In this cohort study, individuals receiving methylphenidate had a small increased cardiovascular risk vs matched controls in the 6 months after treatment initiation. However, there was little evidence for an increased risk of 20% or higher and for differences in risk increase between people with and without a history of cardiovascular disease. Therefore, before treatment initiation, careful consideration of the risk-benefit trade-off of methylphenidate would be useful, regardless of cardiovascular history.

Authors & Co-authors:  Garcia-Argibay Bürkner Lichtenstein Zhang D'Onofrio Andell Chang Cortese Larsson

Study Outcome 

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Statistics
Citations :  Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol. 2014;43(2):434-442. doi:10.1093/ije/dyt261
Authors :  9
Identifiers
Doi : e241349
SSN : 2574-3805
Study Population
Male
Mesh Terms
Male
Other Terms
Study Design
Cohort Study
Study Approach
Country of Study
Publication Country
United States