title: Cardiovascular safety of stimulants in children: findings from recent population-based cohort studies.
abstract: The past decade has seen a heated debate over the cardiac safety of central nervous system stimulants in the treatment of ADHD. This review discusses five controlled population-based studies that investigated this risk in children in the United States. All studies utilized administrative claims data of private or public insurance to compare risk of stimulant use to non-use. Two studies with smaller sample size lacked the ability to investigate serious events but report a slightly increased risk of emergency department visits attributed to cardiac symptoms such as tachycardia or palpitation. Three studies that enrolled more than one million patients found no association between stimulants and composite endpoints of sudden cardiac death, myocardial infarction, stroke and ventricular arrhythmia. The studies concur that background rates of serious cardiovascular events in children are extremely small. No study exceeded an average follow-up of two years, prohibiting inferences about long-term effects of stimulants.
authors.affiliation: Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL 32611, USA. almut@cop.ufl.edu
authors.forename: Almut G
authors.initials: AG
authors.lastname: Winterstein
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D014481:United States; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants
references.citation: Biol Psychiatry. 2006 May 1;59(9):829-35
references.pmid: 16373066
references.citation: N Engl J Med. 2011 Nov 17;365(20):1896-904
references.pmid: 22043968
references.citation: J Am Coll Cardiol. 1997 Mar 15;29(4):709-15
references.pmid: 9091514
references.citation: Pediatrics. 2007 Dec;120(6):e1494-501
references.pmid: 18055666
references.citation: Pediatr Nephrol. 2006 Jan;21(1):92-5
references.pmid: 16254730
references.citation: N Engl J Med. 2000 Dec 21;343(25):1826-32
references.pmid: 11117973
references.citation: Pediatrics. 2011 Jun;127(6):1102-10
references.pmid: 21576311
references.citation: MMWR Morb Mortal Wkly Rep. 2010 Nov 12;59(44):1439-43
references.pmid: 21063274
references.citation: J Am Acad Child Adolesc Psychiatry. 2001 May;40(5):525-9
references.pmid: 11349696
references.citation: BMJ. 2012 Jul 18;345:e4627
references.pmid: 22809800
references.citation: Pediatrics. 2009 Jul;124(1):e75-80
references.pmid: 19564272
references.citation: Ann Pharmacother. 2002 Jul-Aug;36(7-8):1142-9
references.pmid: 12086544
references.citation: N Engl J Med. 2006 Apr 6;354(14):1445-8
references.pmid: 16549404
references.citation: Arch Pediatr. 2004 Jan;11(1):24-8
references.pmid: 14700756
references.citation: J Am Acad Child Adolesc Psychiatry. 2012 Feb;51(2):147-56
references.pmid: 22265361
references.citation: Am J Med. 2003 Jan;114(1):51-5
references.pmid: 12543289
references.citation: CNS Spectr. 2005 Dec;10(12 Suppl 20):35-43
references.pmid: 16344839