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Methylphenidate and Short-Term Cardiovascular Risk
Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-4811-2330
Cluster of Excellence SimTech, University of Stuttgart, Stuttgart, Germany.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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2024 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 7, no 3, article id e241349Article in journal (Refereed) Published
Abstract [en]

Importance:  There are concerns about the safety of medications for treatment of attention-deficit/hyperactivity disorder (ADHD), with mixed evidence on possible cardiovascular risk.

Objective:  To assess whether short-term methylphenidate use is associated with risk of cardiovascular events.

Design, Setting, and Participants:  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.

Main Outcomes and Measures:  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.

Results:  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).

Conclusions and Relevance:  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.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2024. Vol. 7, no 3, article id e241349
National Category
Cardiology and Cardiovascular Disease Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-112148DOI: 10.1001/jamanetworkopen.2024.1349ISI: 001181344100005PubMedID: 38446477Scopus ID: 2-s2.0-85187197420OAI: oai:DiVA.org:oru-112148DiVA, id: diva2:1842942
Funder
The Swedish Brain Foundation, FO2021-0115Swedish Research Council, 2018-02599Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-01172EU, Horizon 2020, 965381Available from: 2024-03-06 Created: 2024-03-06 Last updated: 2025-02-10Bibliographically approved

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Garcia-Argibay, MiguelLarsson, Henrik

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