Adult ADHD Medications and Their Cardiovascular Implications

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobiological disorder exhibited by difficulty maintaining attention, as well as hyperactivity and impulsive behavior. Central nervous system (CNS) stimulants are the first line of treatment for ADHD. With the increase in number of adults on CNS stimulants, the question that arises is how well do we understand the long-term cardiovascular effects of these drugs. There has been increasing concern that adults with ADHD are at greater risk for developing adverse cardiovascular events such as sudden death, myocardial infarction, and stroke as compared to pediatric population. Cardiovascular response attributed to ADHD medication has mainly been observed in heart rate and blood pressure elevations, while less is known about the etiology of rare cardiovascular events like acute myocardial infarction (AMI), arrhythmia, and cardiomyopathy and its long-term sequelae. We present a unique case of AMI in an adult taking Adderall (mixed amphetamine salts) and briefly discuss the literature relevant to the cardiovascular safety of CNS stimulants for adult ADHD.

Assessment of Stimulant Use and Cardiovascular Event Risks Among Older Adults

“…Furthermore, known common side effects associated with stimulants described in the literature include tachycardia, arrhythmias, and blood pressure elevation. 49 The 300% increases in risk for arrhythmias at 30 days (HR, 3.0; 95% CI, 1.1-8.7) and 180 days (HR, 3.0; 95% CI, 1.4-6.4) identified in this study support these literature findings. 50 On the other hand, our finding that there was no statistically significant increase in CV risk long term contradicts the anticipated hypothesis based on findings from a meta-analysis of 10 randomized, placebo-controlled trials of CNS stimulants that found a statistically significant increased resting heart rate with these stimulants (increase of 5.7 bpm; 95% CI, 3.6-7.8 bpm) and systolic blood pressure (increase of 2.0 mm Hg; 95% CI, 0.8-3.2 mm Hg).…”

“…Furthermore, known common side effects associated with stimulants described in the literature include tachycardia, arrhythmias, and blood pressure elevation. 49 The 300% increases in risk for arrhythmias at 30 days (HR, 3.0; 95% CI, 1.1-8.7) and 180 days (HR, 3.0; 95% CI, 1.4-6.4)…”

Bridging Neurodiversity and Open Scholarship: How Shared Values Can Guide Best Practices for Research Integrity, Social Justice, and Principled Education

“…For example, it can be difficult to disentangle the cause and therefore access to appropriate diagnoses/support for issues like poor working memory ("brain fog"), which is common with ADHD/ADHC, as it is for chronic inflammatory conditions like arthritis or lupus (Mackay, 2015). For ADHD/ADHC individuals with heart conditions, it can be harder to manage their ADHD/ADHC where often the first line of treatment is stimulant medication, due to increased risk of heart problems (Sinha et al, 2016). For neurodivergent individuals experiencing a flare up in their chronic illness (e.g., increased pain and/or fatigue and brain fog), it can further exacerbate executive functioning issues already present with their neurodivergent condition.…”

A Case of Esmolol-Induced False-Positive Amphetamine Urine Drug Test

“…Another risk factor to consider in this case report is the patient’s morbid obesity (BMI: 69.81) with a relationship with new-onset atrial fibrillation. Although some case reports suggest a relationship between amphetamine use and new-onset atrial fibrillation, this patient had several other independent risk factors for new-onset atrial fibrillation [ 14 - 15 ]. Obese individuals have a 49% increased risk of developing atrial fibrillation as compared to non-obese individuals, with a positive correlation between increasing BMI and risk of developing atrial fibrillation [ 16 ].…”