title: Stimulants and cardiovascular events in youth with attention-deficit/hyperactivity disorder.
abstract: OBJECTIVE
  This study examined associations between stimulant use and risk of cardiovascular events and symptoms in youth with attention-deficit/hyperactivity disorder and compared the risks associated with methylphenidate and amphetamines.
  
  
  METHODS
  Claims were reviewed of privately insured young people 6 to 21 years old without known cardiovascular risk factors (n = 171,126). A day-level cohort analysis evaluated the risk of cardiovascular events after a diagnosis of attention-deficit/hyperactivity disorder in relation to stimulant exposures. Based on filled stimulant prescriptions, follow-up days were classified as current, past, and no stimulant use. Endpoints included an emergency department or inpatient diagnosis of angina pectoris, cardiac dysrhythmia, or transient cerebral ischemia (cardiac events) or tachycardia, palpitations, or syncope (cardiac symptoms).
  
  
  RESULTS
  There were 0.92 new cardiac events and 3.08 new cardiac symptoms per 1,000,000 days of current stimulant use. Compared with no stimulant use (reference group), the adjusted odds ratios of cardiac events were 0.69 (95% confidence interval 0.42-1.12) during current stimulant use and 1.18 (95% CI 0.83-1.66) during past stimulant use. The corresponding adjusted odds ratios for cardiac symptoms were 1.18 (95% CI 0.89-1.59) for current and 0.93 (95% CI 0.71-1.21) for past stimulant use. No significant differences were observed in risks of cardiovascular events (2.14, 95% CI 0.82-5.63) or symptoms (1.08, 95% CI 0.66-1.79) for current methylphenidate use compared with amphetamine use (reference group).
  
  
  CONCLUSIONS
  Clinical diagnoses of cardiovascular events and symptoms were rare and not associated with stimulant use. The results help to allay concerns over the cardiovascular safety of stimulant treatment for attention-deficit/hyperactivity disorder in young people without known pre-existing risk factors.
authors.affiliation: New York State Psychiatric Institute, New York, NY 10032, USA. mo49@columbia.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.forename: Cecilia
authors.initials: C
authors.lastname: Huang
authors.forename: Tobias
authors.initials: T
authors.lastname: Gerhard
authors.forename: Almut G
authors.initials: AG
authors.lastname: Winterstein
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: Paul D
authors.initials: PD
authors.lastname: Allison
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D000662:Amphetamines / Q000009:adverse effects* / Q000627:therapeutic use; D000787:Angina Pectoris / Q000139:chemically induced / Q000175:diagnosis; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000175:diagnosis; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000175:diagnosis; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000139:chemically induced / Q000175:diagnosis; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects* / Q000627:therapeutic use; D016017:Odds Ratio; D057216:Propensity Score; D013575:Syncope / Q000139:chemically induced / Q000175:diagnosis; D013610:Tachycardia / Q000139:chemically induced / Q000175:diagnosis; D055815:Young Adult
chemical_list: D000662:Amphetamines; D000697:Central Nervous System Stimulants; D008774:Methylphenidate