ADHD medication not associated with cardiovascular risk | Hacker News Reader

ADHD medication not associated with cardiovascular risk

additudemag.com

49 pointsquadportnick58 comments

"ADHD medications — both stimulants and non-stimulants — do not place patients of any age at greater risk for cardiovascular events such as heart failure and hypertension. This groundbreaking finding comes from a new meta-analysis of 19 observational studies, including 3.9 million participants, that found no statistically significant association between ADYD medications and cardiovascular disease (CVD), even among middle-aged and older adults.

The analysis, published November 23 in JAMA Network Open, is the most comprehensive systematic review and meta-analysis of longitudinal observational studies to date on the association between ADHD medication use and the risk of CVD. It included patients from the United States, South Korea, Canada, Denmark, Spain, and Hong Kong. It found no associations between ADHD medication use and a higher incidence of CVD, however, it did recommend further research on the risk of cardiac arrest and tachyarrhythmias among female patients and patients with pre-existing CVD."

Article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

Thanks for posting the source article!

> “This is probably the single biggest false belief about ADHD medications… Taking stimulant medications does not increase your cardiovascular risk at all, zero, nothing,” Dodson said. “Cardiologists know that these medications are dangerous and that there is lots of research to support that.”

So, which is it? Are they dangerous, or not dangerous?

From the other replies it sounds like it's just a typo, but to be fair, the quote isn't really a contradiction as it is written; jumping off cliffs is known to be dangerous, but it also almost guarantees that you won't die from a heart attack!

Given the context (especially other quotes from Dr. Dodson) I think it's reasonable to assume that the word "not" was dropped, i.e. "Cardiologists know that these medications are NOT dangerous".

Acutely, in a large dose they are harmful. Long-term chronic exposure at a therapeutic dose monitored by a physician is not associated with harm.

The monitoring is critical. You are both having a heart attack and not having one simultaneously, by having the doctor observe you, you collapse the heart attack wave function and come out the other side not having had a heart attack.

Seems like an editing error, the second sentence should say 'not dangerous' (going by his quotes elsewhere in the article).

Danger of abuse?

I was diagnosed with ADHD a couple of months ago and since being on medication, my life has never been better. I'm able to sit through a full day at work and maintain productivity throughout the day. I don't binge eat for every meal. I'm able to easily get up and do chores when they need to be done.

I'm sorry to see that medication hasn't worked for a lot of people in the comment section, but so far for me things have only been positive.

I really hope this is the case but like all "groundbreaking" discoveries, I'm going to take this with a grain of salt (because any more salt than that is going to send my BP even higher).

For me I decided it was worth the risk. I've had great BP my entire life, so since starting stimulant medication over a year ago it really does push my BP to the limit of "ok" and into the start of "let's keep and eye on it" territory, which means I'm probably overly cautious, but it's hard not to be when you notice something really different to your usual baseline. Especially since I need to take additional medication in the evening to reduce my heart rate before I go to bed or I won't be able to sleep.

I hope this opens up a treatment pathway for a lot of people who need it. Especially those with a late diagnosis for whom it would be beneficial to finally give them the space to make lasting change/progress.

“The results of this meta-analysis suggested no statistically significant association between ADHD medication use and the risk of any cardiovascular events across age groups, although a modest risk increase could not be excluded, especially for the risk of cardiac arrest or tachyarrhythmias,”

So, there is a risk for now? Or the risk of a risk?

Yea that seems rather confusing. Is "modest" different than "significant"?

The smaller the effect, the harder it is to find. Basically, they're saying "we took a look, and saw nothing bad. Therefore, either (1) these medications don't increase risk of cardiovascular disease or (2) they do, but only slightly (the risk increase was too small for us to find.)"

Of course there is a risk.

This seems like a better interpretation (linked and mentioned in the article):

https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

Cheers - better technical discussion being an orig paper on the subject:

> Zhang et al performed a meta-analysis of 19 observational studies with more than 3.9 million participants followed from 3 months to 9.5 years (median follow-up, 1.5 years) and found no association between use of medications to treat attention-deficit/hyperactivity disorder (ADHD) and any cardiovascular disease (CVD) outcome.

Caveats (my thoughts on what to look into):

* Meta analysis of other studies can be a real mixed bag, they almost always deserve a closer look.

* Median Follow-up 1.5 years means half of the patients were tracked for less than 18 months ... (hmmm)

* With no distribution it's possible that literally one patient was tracked for 9.5 years, and the vast bulk of patients for under three years ...

* "Found no association" is a statement that is consistent with none of the studies showing a significant above expected number of heart issues; this may be because the bulk of the studies were too short term and (possibly) not especially focused on such issues - hence the need to look deeper.

I have no opinion either way, just the above notes on where to look further.

> Meta analysis of other studies can be a real mixed bag, they almost always deserve a closer look.

My understanding was that meta analyses were better than individual studies, since they are 'samples of samples,' so to speak --- admittedly my understanding of the matter comes from the picture at the top of [0] though.

[0] https://flexiblelearning.auckland.ac.nz/philson/51_5.html

> My understanding was that meta analyses were better than individual studies, since they are 'samples of samples,' so to speak

In principle and in theory .. yes.

In practice some can be "publish or perish" pumped papers that are thrown out at speed at lack deep insight when comparing apples, pears, and oranges.

They're also rather notorious for having been quoted during the recent pandemic years to support every COVID claim you care to mention (ie. vaccines good, vaccines bad, masks good, masks bad, horse dewormer good, etc. )

A good meta study paper is a mine of useful infomation, a poor one is grist for conspiracy mills.

Thank you for sharing this interpretation!

Very good study. Thanks for sharing!

I know the stimulant class of meds for ADHD may cause hypertension, and more rarely, tachycardia. Therefore I thought in the long term they posed a risk to the cardiovascular system, causing remodeling of the heart and what not.

My takeaway is that if a person keeps healthy, doesn't abuse them, and takes appropriate drug holidays, it apparently is statistically safe, at least for the heart.

Few years ago my PCP did EKG before prescribing me an ADHD medication and discovered some abnormality that lead to finding out that I have Wolff Parkinson White syndrome (left untreated could potentially cause cardiac arrest). My condition as fixed after having ablation surgery. I guess takeaway is that everybody should have EKG from time to time despite the need to get ADHD prescription.

Yeah. EKGs are easy, cheap, fast, universally available and risk-free. I can't think of a reason not to do one.

Purely anecdotal, but I have observed very poor outcomes for people who started on ADHD medication when young. Maybe a biased sample, but having grown up now and seen it, I believe those drugs are poison, especially when given to teenagers and younger.

Outcomes for people with untreated ADHD are really bad. Something like half the prison population has ADHD, compared to under 5% of the general public. https://add.org/undiagnosed-adult-adhd-a-high-cost-for-socie...

Definitely biased. In patients with ADHD, childhood treatment has been strongly correlated with better outcomes in long term studies.

Very anecdotal here, but I wouldn't be the successful person I am had I not been given medication when I was young, starting in third grade. Night and day difference when I was on it. The medication made me a functioning person who could pay attention and do what I was supposed to do.

However, my doctors treated me with medication _and_ had me go to a therapist for cognitive behavioral therapy. The medication helped me learn to slow down my mind, be able to focus when I normally couldn't, and develop the coping skills that allowed me to function that I was learning in therapy.

My doctors also had never planned for the medication to be long term for me. It was a tool to help the therapy take hold. I was on it for about five or six years, slowly weaning me off in 7th grade once I'd developed the proper skills. I haven't taken any of that medication since then.

I don't think many paired it with therapy back then. Maybe they still don't. But I use those tools I developed in Therapist Bob's office all those years ago on a daily basis. I never could've paid attention to what that man was saying had I not been on medication. Saved my life.

How do the outcomes compare to people with ADHD who were unmedicated? It's possible that the medicated outcomes are poor and yet still better than the unmedicated outcomes.

I'm just saying I have a number of cousins, friends, etc who have been on them a long time. Very few of them completed college, have a career. A lot of them have anxiety, depression, and general maladjustment. If thats what they got out of the medication then they got nothing, they would have been better off spending their youth sober and healthy.

I mean, it's a neurodevelopmental disorder that makes it hard for people to accomplish tasks. And what you're describing just seem like all the symptoms people with ADHD would have.

This isn't a perfect analogy, but it's kind of like saying a guy isn't a great runner because he tore his ACL and surgeons fixed it but it's still messed up, and saying he should've just never gotten the surgery.

You're blaming the medication when people with ADHD are already predisposed to not being able to complete things, have normal careers, and are at high risk for anxiety, depression and other things. You're just seeing what ADHD looks like.

You likely have some cousins, friends, etc that have had much harder lives than you appreciate. Especially if you view this as not being sober... Correctly medicated ADHD people should not in any way compared to drugged or drunken people.

Yes, having major difficulties concentrating on school or work tends to cause anxiety, depression and maladjustment.

Stimulant medications are not a cure, but they do improve quality of life in ADHD patients compared to baseline.

> I have observed very poor outcomes for people who started on ADHD medication when young

Relative to the outcome for those same people had they remained untreated, or a "control group" of people with ADHD who were untreated, or just relative to neurotypical/non-ADHD people in general? Maybe ADHD has a negative impact even when treated.

> I believe those drugs are poison, especially when given to teenagers and younger.

You're making a dangerously uninformed claim. Actual, non-anecdotal, peer-reviewed studies strongly suggest the opposite of your observation. Untreated ADHD can have profoundly negative consequences.

I love stimulants for my ADHD, but totally agree that my friends taking them while we were growing up had pretty negative outcomes. One friend was taking 2 20mg pills a day as a 100lb 13 year old while I am taking 10mg a few times a week. The idea of pumping that much into a developing person and never letting their brain have a break from it is insane.

They are noticeably spacey as an adult to the point where I am not super comfortable driving with them. Running stop signs and red lights is a frequent occurrence.

> my friends taking them while we were growing up had pretty negative outcomes.

Or - hear me out - maybe severe ADHD, the kind that leads to diagnosis and treatment with stimulant medication at a very young age, is correlated with negative outcomes in general. You know, like a disability.

The number of people willing to believe - contrary to actual peer reviewed studies - that stimulant medication is harmful to people with ADHD, based on nothing more than a gut feeling, is astounding. People don't assume they can just intuit the proper treatment for other medical conditions, why do they think they can do that with mental health related issues?

I mean look, I can see it with my own two eyes. The gauntness in their face, the effect it has on their emotions over years of use. Knowing someone and seeing them go down hill and struggle, and then be better during the summers when they are off it.

I'm not asserting stimulant medications have no side effects.

I am asserting that decades and decades of peer-reviewed medical literature indicates that stimulant medications are a net benefit for people with ADHD.

This is not a controversial perspective among informed researchers or clinicians.

I agree but I also acknowledge that the approach psychiatrists use can be damaging by over-relying on medications. I have adult-diagnosed ADHD and are aware on how easy it is for a psychiatrist/parent to up the dose just to make the person more "compliant". These medications are powerful but also need other kinds of supports, such as socially and intellectually. These supports can be a nurturing environment, intellectual group to bounce ideas off and feel belonging there.

> to the point where I am not super comfortable driving with them. Running stop signs and red lights is a frequent occurrence

You're almost certainly right about that. Accidents in general [1] and car accidents in particular [2] are more common for people with ADHD.

The part you're missing is that the stimulant medication _improves_ the situation.

Quoting from the results of the second study referenced above:

> Compared with individuals without ADHD, male ADHD patients [...] had increased risk of serious transport accidents. In male ADHD patients, ADHD medication was associated with a 58% risk reduction [....] Estimates of the population attributable fractions suggested that 41% – 49% of the accidents in male patients with ADHD could have been avoided if they had been on treatment the entire follow-up.

[1] https://pubmed.ncbi.nlm.nih.gov/33582234/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949159/

Do you know if they were using other forms of treatment alongside medication? Or was medication their only treatment?

What kind of outcomes? Please share, very interested.

Seems that the same ones who were put on these meds from a young age are the same ones who are most vocally suffering from anxiety and depression. Jury's out on whether the meds were because of substandard upbringing (kids acting up, get them meds or they're out of this magnet school), and whether that has an effect on the psyche later in life.

This can just be selection bias, though. People with ADHD are much more predisposed to anxiety and mood disorders(also addiction and psychosis).

Medicine can help, but they're not a silver bullet.

So it could just be that the people you've noticed are just people who are more likely to develop these problems.

And if you want an anecdatum, I have ADHD, unmedicated during most of my childhood, and I went to develop all of the above except for psychosis.

ADHD has a ~30% rate of comorbidity (some sources say as high as 40% to 60%) with both anxiety and depression (and, as you note, is also correlated with other issues such as bipolar disorder and substance abuse).

Moreover, delayed diagnosis ADHD is even _more_ correlated with issues like anxiety than the ADHD population in general. If you think about it, that outcome is predicable: a lifetime of experiencing the kinds of problems created by executive dysfunction (especially with little or no understanding or explanation of the phenomenon) is a perfect breeding ground for anxiety or depression or both.

I'm not sure if the same statement is true for diagnosed but untreated ADHD, but certainly seems plausible.

> This can just be selection bias, though.

Absolutely, you are correct. To be clear, that's 100% a hunch I just posted, based on no data or experience other than the people I have known that long who are now adults. Funny thing, a lot of them are deciding not to medicate their children.

Always so many psychological problems. Heavy anxiety and depression, psychosis, social problems. Just maladjustment all over the place.

But those issues are highly correlated with ADHD itself. Why would you assume that stimulant medication is the cause?

In fact, data suggest that the problems you observed probably would have been worse absent the stimulant medication. A treatment can be beneficial even if it doesn't completely eliminate the associated issues.

Yay, maybe I can stop having to take an EKG 4 times a year.

Definitely twice a year at least if you're on stimulants.

I've been on them for 8 years, and I have never had one.

I took stimulants at therapeutic doses for 8 years(Adderall and Vyvanse mostly) - I think more study is needed before we can say with confidence that there is no cardio risk associated with ADHD meds.

I have no history of CVD, but on occasion these meds will give me chest pains and palpitations. So much so that I recently decided to stop taking them and see a cardiologist. The cardiologist did not note any damage, but after the chest pain, palpitations, and seeing my HR hit BPMs that would scare most doctors... I'm not confident in these results.

Can someone with time/interest check to see if there is some p-hacking going on here?

It's possible you were on too high of a dose. Stimulants definitely increase pulse, and palpitations are a common side effects, but they're not necessarily indicative of any danger, though it's very understandable that they can be scary.

> This groundbreaking finding comes from a new meta-analysis of 19 observational studies, including 3.9 million participants

ADHD medications, particularly Adderall, are very well studied. Amphetamine formulations have been prescribed for alertness since the 1930s.

Want to chime in and say I took a very low dose as prescribed for 2 years. I started experiencing random high blood pressure, random heart rate spikes, worsening anxiety and panic. This was the worst when I'd take a day or two break. The doctor told me to start taking anti anxiety meds or take even more Adderall. That made me decide to stop all together.

I do miss being able to do things on will. But over time the benefits started wearing off, and the drawbacks were horrible and scary to experience.

Amphetamines are sympathomimetic. On the heart, they have adrenalin-like inotropic and chronotropic effects. Heart beats faster and stronger, leading to higher heart rate, higher blood pressure, palpitations, higher oxygen consumption. It was theorized that these effects increased cardiovascular risk but apparently that is not the case according to TFA, at least with prescription amphetamines at therapeutic dosages. Abuse of methamphetamine definitely increases risk though. It seems to be common practice to use beta blockers like atenolol to treat the side effects if present.

Amphetamines can definitely alter your mood and worsen symptoms of anxiety.

Did you drink coffee?

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