title: ADHD drugs and serious cardiovascular events in children and young adults.
abstract: BACKGROUND
  Adverse-event reports from North America have raised concern that the use of drugs for attention deficit-hyperactivity disorder (ADHD) increases the risk of serious cardiovascular events.
  
  
  METHODS
  We conducted a retrospective cohort study with automated data from four health plans (Tennessee Medicaid, Washington State Medicaid, Kaiser Permanente California, and OptumInsight Epidemiology), with 1,200,438 children and young adults between the ages of 2 and 24 years and 2,579,104 person-years of follow-up, including 373,667 person-years of current use of ADHD drugs. We identified serious cardiovascular events (sudden cardiac death, acute myocardial infarction, and stroke) from health-plan data and vital records, with end points validated by medical-record review. We estimated the relative risk of end points among current users, as compared with nonusers, with hazard ratios from Cox regression models.
  
  
  RESULTS
  Cohort members had 81 serious cardiovascular events (3.1 per 100,000 person-years). Current users of ADHD drugs were not at increased risk for serious cardiovascular events (adjusted hazard ratio, 0.75; 95% confidence interval [CI], 0.31 to 1.85). Risk was not increased for any of the individual end points, or for current users as compared with former users (adjusted hazard ratio, 0.70; 95% CI, 0.29 to 1.72). Alternative analyses addressing several study assumptions also showed no significant association between the use of an ADHD drug and the risk of a study end point.
  
  
  CONCLUSIONS
  This large study showed no evidence that current use of an ADHD drug was associated with an increased risk of serious cardiovascular events, although the upper limit of the 95% confidence interval indicated that a doubling of the risk could not be ruled out. However, the absolute magnitude of such an increased risk would be low. (Funded by the Agency for Healthcare Research and Quality and the Food and Drug Administration.).
authors: Division of General Pediatrics, Vanderbilt University, Nashville, TN 37232-4313, USA. william.cooper@vanderbilt.edu
authors: William O
authors: WO
authors: Cooper
authors: Laurel A
authors: LA
authors: Habel
authors: Colin M
authors: CM
authors: Sox
authors: K Arnold
authors: KA
authors: Chan
authors: Patrick G
authors: PG
authors: Arbogast
authors: T Craig
authors: TC
authors: Cheetham
authors: Katherine T
authors: KT
authors: Murray
authors: Virginia P
authors: VP
authors: Quinn
authors: C Michael
authors: CM
authors: Stein
authors: S Todd
authors: ST
authors: Callahan
authors: Bruce H
authors: BH
authors: Fireman
authors: Frank A
authors: FA
authors: Fish
authors: Howard S
authors: HS
authors: Kirshner
authors: Anne
authors: A
authors: O'Duffy
authors: Frederick A
authors: FA
authors: Connell
authors: Wayne A
authors: WA
authors: Ray
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants