To Örebro University

Background: Attention-deficit/hyperactivity disorder (ADHD) may be associated with up to a two-fold increase in cardiovascular disease (CVD) incidence in adulthood. However, cardiovascular medicine use to prevent and manage CVDs among adults with ADHD is understudied.

Objectives: This cross-sectional study aimed to compare patterns of real-world cardiovascular medicine use between Australian adults with and without ADHD, by estimating the prevalence of cardiovascular medicine use in both groups and quantifying the difference through prevalence ratios (PRs), over-all and by sex, age and medicine type.

Methods: Using a nationally representative dispensings sample from the Pharmaceutical Benefits Scheme, we identified 14,753 adults with ADHD, defined as ≥ 2 dispensings of ADHD medicines from 2012 to 2020 (18–29 [41.5%], 30– 49 [43.0%], 50– 64 [12.5%], ≥ 65 [3.0%] years). We randomly selected 59,012 age- and sex-matched adults without ADHD. We estimated the prevalence of cardiovascular medicine use (2021) among adults with and without ADHD by sex and age group and by medicine type. To examine the association of ADHD with cardiovascular medicine use, we calculated PRs with 95% confidence intervals (CIs) adjusting for age and sex, using Poisson regression. We conducted a post hoc analysis excluding propranolol, due to common off-label use.

Results: Compared with those without ADHD, adults with ADHD had higher use of cardiovascular medicines, with an elevated prevalence for antithrombotic agents (2.2% vs. 1.4%), non-selective beta-blocker (propranolol) (3.2% vs. 0.7%), loop diuretics (0.8% vs. 0.4%) and potassium-sparing diuretics (0.9% vs. 0.4%). Overall cardiovascular medicine use was also more prevalent (16.5% vs. 10.0%, PR: 1.7, 95% CI: 1.6–1.7), with the highest difference among adults aged 18–29 (6.0% vs. 2.2%, PR: 2.8, 95% CI: 2.4–3.1). Stratified by sex, we observed an elevated prevalence of propranolol, furosemide, and spironolactone among females with ADHD, compared with females without ADHD but not among males, suggesting potential effect modification by sex. In the post hoc analysis, PRs decreased slightly, but patterns of use remained consistent across age and sex, with the highest relative difference still among adults aged 18–29 (3.6% vs. 1.6%, PR: 2.2,95% CI: 1.9–2.6).

Conclusions: The association between ADHD and cardiovascular medicines was strongest in young adults, indicating a high relative burden of CVD in this group. We identified that the elevated use of cardiovascular medicine among young adults with ADHD was partly driven by propranolol. Our findings support that clinicians should ensure regular cardiovascular assessment for people with ADHD and underscore young adulthood as a critical period for cardiovascular screening.