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WHAT'S KNOWN ON THIS SUBJECT:Attention-deficit/ hyperactivity disorder agents increase systolic and diastolic blood pressure and heart rate. Case reports of sudden death in children and adolescents receiving these agents have led to the concern that they might increase the risk of cardiovascular events. WHAT THIS STUDY ADDS:Low rates of validated cardiovascular events and of all-cause death, nonsuicide, and non-accidental death were found in children and adolescents receiving attention-deficit/ hyperactivity disorder medications.abstract OBJECTIVE: The objective of this study was to compare the rate of severe cardiovascular events and death in children who use attentiondeficit/hyperactivity disorder (ADHD) medications versus nonusers. PATIENTS AND METHODS:We performed a large cohort study using data from 2 administrative databases. All children aged 3 to 17 years with a prescription for an amphetamine, atomoxetine, or methylphenidate were included and matched with up to 4 nonusers on the basis of data source, gender, state, and age. Cardiovascular events were validated using medical records. Proportional hazards regression was used to calculated hazard ratios. RESULTS: We identified 241 417 incident users (primary cohort) CONCLUSIONS:The rate of cardiovascular events in exposed children was very low and in general no higher than that in unexposed control subjects. Because of the low number of events, we have limited ability to rule out relative increases in rate.

Although initiation of methylphenidate was associated with a 1.8-fold increase in risk of sudden death or ventricular arrhythmia, the lack of a dose-response relationship suggests that this association may not be a causal one.

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