To Örebro University

AIMS: Attention-deficit/hyperactivity disorder (ADHD) is increasingly diagnosed in adults and is associated with cardiometabolic diseases. Yet, the associations between ADHD and cardiometabolic risk profile, participation in non-pharmacological interventions, and long-term outcomes in patients with myocardial infarction (MI) remain unclear.

METHODS AND RESULTS: This observational study involved patients from the SWEDEHEART (the Swedish Web-system for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapy) registry, aged 18-74 years old, diagnosed with their first acute MI from 2006 to 2020. We assessed the associations between ADHD and cardiometabolic risk profile (clinical parameters, disease histories, and behavioural factors), engagement in guideline-recommended non-pharmacological interventions, recurrent cardiovascular events, and mortality. We analysed adults with MI with ADHD (n = 582) and without ADHD (n = 2704). Most clinical parameters and disease histories did not differ significantly between groups. However, patients with ADHD had higher risks of smoking (risk ratio, RR = 1.53; 95% confidence interval 1.36-1.71] and snus use (RR = 1.65; 1.36-1.99), were less likely to participate in follow-up evaluations (RR = 0.87; 0.79-0.96), or to stop smoking after MI (RR = 0.76; 0.63-0.91). They had a higher rate of all-cause mortality (hazard ratio = 2.02; 1.05-3.88) after discharge, but not recurrent cardiovascular events.

CONCLUSION: Adults with MI and ADHD present similar cardiometabolic risk profiles but poorer lifestyle behaviours, lower engagement in recommended interventions, and higher mortality compared with those without ADHD, underscoring the need for integrated cardiology care with psychiatric services.