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A study by William Cooper, M.D., and colleagues found that ADHD drugs do not increase the risk of heart disease or heart attack in the children who take them. (photo by Joe Howell)

Study finds no heart risk with ADHD drugs


11/03/2011 - Attention deficit hyperactivity disorder (ADHD) medications do not increase the risk for heart disease or heart attack in children and young adults, according to a Vanderbilt study of 1.2 million patients taking drugs including Ritalin, Adderall, Concerta and Strattera between 1998 and 2005.

The study, published this week in the New England Journal of Medicine (NEJM) and authored by William Cooper, M.D., MPH, professor of Pediatrics and Preventive Medicine, is the largest ever to examine potential risks posed by drugs to treat ADHD.

“It should be reassuring that we found no evidence that these drugs increase the risk of serious cardiovascular events on a population basis,” Cooper said.

“However, each child is unique, so families and providers need to work together to make informed decisions about the best options for their children. This is especially true for children who have any chronic health conditions or special health needs.”

ADHD, the most common neurobehavioral disorder in childhood, is characterized by inattention, overactivity and impulsivity.

Cooper and colleagues reviewed medical records from four health plans for more than 1.2 million children and young adults ages 2-24.

Data collected from 1998-2005 were examined for serious cardiovascular events including sudden cardiac death, heart attack and stroke.

Current users of ADHD medications and their health records were compared with individuals who were not using ADHD medications.
Over the seven-year period, 81 cases of serious heart problems, or about three cases per 100,000, were documented.

There was no significant increase in risk of these events for patients who used ADHD medications compared with those who did not, Cooper said.

The Food and Drug Administration issued a black-box advisory in 2006, linking ADHD medications and potential heart risk.

Then, in 2008, the American Heart Association reviewed existing research and concluded it was reasonable for physicians to obtain an electrocardiogram (EKG) before prescribing ADHD medications.

“We hope that the study will provide evidence to guide future recommendations for whether children without a history of heart problems should be tested before starting ADHD medications,” Cooper said.

The study was supported by the Agency for Healthcare Research and Quality’s (AHRQ) Effective Health Care program and the FDA.

Other authors from Vanderbilt include:

• Wayne Ray, Ph.D., professor of Preventive Medicine and senior author of the study;
• S. Todd Callahan, M.D., MPH, assistant professor of Pediatrics;
• Frank Fish, M.D., professor of Pediatrics;
• C. Michael Stein, M.B.Ch.B., professor of Clinical Pharmacology;
• Katherine Murray, M.D., associate professor of Clinical Pharmacology;
• Howard Kirshner, M.D., professor of Psychiatry;
• Anne O’Duffy, M.D., assistant professor of Neurology; and
• Patrick Arbogast, Ph.D., associate professor of Pharmacoepidemiology.

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