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Attention-deficit/hyperactivity disorder symptoms and subsequent cardiometabolic disorders in adults: investigating underlying mechanisms using a longitudinal twin study
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-3887-9669
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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2023 (English)In: BMC Medicine, E-ISSN 1741-7015, Vol. 21, no 1, article id 452Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Emerging research suggests that attention-deficit/hyperactivity disorder (ADHD) increases the risk for cardiovascular (CVDs) and metabolic disorders (i.e., cardiometabolic disorders) in adulthood. Yet, available studies are scarce and have mainly been focused on individuals receiving clinical ADHD diagnoses. We aimed to investigate the prospective associations of ADHD symptoms in young and mid-adulthood with subsequent cardiometabolic disorders and the underlying mechanisms.

METHODS: We studied 10,394 twins from the Swedish Twin Registry (STR), born between 1958 and 1985 without previous medical history of cardiometabolic disorders. They provided self-assessment of ADHD symptoms (score range 0-36) via a validated, DSM-IV-based scale in a web-based questionnaire/telephone interview within the Study of Twin Adults: Genes and Environment (STAGE), in 2005-2006 (aged 19-47 years), and were followed until the end of 2018 (33-59 years) to identify incident clinical diagnoses/medication prescriptions for cardiometabolic disorders acquired from Swedish national registers. We used Cox regression models to investigate the associations between ADHD symptoms score and cardiometabolic outcomes, with and without adjustment for relevant covariates, and a co-twin control design to study familial confounding.

RESULTS: A one-unit increase in the level of ADHD symptoms was associated with a 2% increase in the rate of CVDs (hazard ratio [HR] = 1.02, 95% confidence interval 1.01-1.04) and a 3% increase in the rate of metabolic disorders (HR = 1.03, 1.02-1.05), after adjusting for birth year and sex. The associations were no longer significant after adjusting for educational attainment, lifestyle factors, and comorbid psychiatric disorders. The associations remained significant after adjusting for familial factors shared by dizygotic twin pairs but became nonsignificant after adjusting for factors shared by monozygotic twin pairs. However, the strength of the associations attenuated significantly in monozygotic twins compared to dizygotic twins for CVDs only, suggesting genetic confounding.

CONCLUSIONS: ADHD symptom score is associated with a higher risk for cardiometabolic disorders, which may be explained by lower educational attainment, adverse lifestyle factors, and psychiatric comorbidities. Moreover, the associations appear to be partly confounded by shared genetic factors, especially for CVDs. Further research is needed to investigate the identified associations at the level of individual cardiometabolic disorders and to follow-up participants until a more advanced older age.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 21, no 1, article id 452
Keywords [en]
ADHD, ADHD symptoms, Adults, Cardiometabolic disorders, Comorbidity, Genetics, Longitudinal study, Twin study, Underlying mechanisms
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-109868DOI: 10.1186/s12916-023-03174-1ISI: 001156832500002PubMedID: 37993878Scopus ID: 2-s2.0-85177569917OAI: oai:DiVA.org:oru-109868DiVA, id: diva2:1814309
Funder
Örebro UniversityEU, Horizon 2020, 754285Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-00176Swedish Research Council, 2018-02599The Swedish Brain Foundation, FO2021-0115Swedish Society for Medical Research (SSMF), PD20-0036Fredrik och Ingrid Thurings Stiftelse, 2021-00638Swedish Psychiatric Foundation
Note

Funding Agencies:

Örebro University

The European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreemen

Swedish Research Council for Health, Working Life, and Welfare 

 Swedish Research Council

The Swedish Brain Foundation

The Swedish Society for Medical Research (SSMF)

Fredrik & Ingrid Thurings Stiftelse

Fonden för Psykisk Hälsa, and The Strategic Research Area in Epidemiology and Biostatistics (SFOepi)

Available from: 2023-11-24 Created: 2023-11-24 Last updated: 2024-02-14Bibliographically approved

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Dobrosavljevic, MajaLarsson, Henrik

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