Author + information
- Received December 4, 2019
- Revision received May 21, 2020
- Accepted May 26, 2020
- Published online August 10, 2020.
- Noel Torres-Acosta, MDa,
- James H. O’Keefe, MDa,b,∗ (, )@MidAmericaHeart,
- Caroline L. O’Keefec and
- Carl J. Lavie, MDd
- aUniversity of Missouri-Kansas City, Kansas City, Missouri
- bSaint Luke’s Mid America Heart Institute, Kansas City, Missouri
- cTulane University, New Orleans, Louisiana
- dJohn Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana
- ↵∗Address for correspondence:
Dr. James H. O’Keefe, Mid America Heart Institute, 4321 Washington Street, Suite 2400, Kansas City, Missouri 64111.
• Use of prescription sympathomimetic drugs for treating ADHD has markedly increased in the United States.
• ADHD medications, potent stimulants of the sympathetic nervous system, are associated with adverse cardiovascular events.
• ADHD medications should be prescribed only after safer options, such as regular exercise and omega-3, have been considered and/or tried.
Although the prevalence of attention-deficit/hyperactivity disorder (ADHD) has been stable over the past 3 decades, prescriptions of sympathomimetic stimulants have steadily increased in the United States. This study consisted of a systematic review of PubMed articles screened for ADHD medications and potential cardiovascular toxicity as well as nondrug strategies for managing ADHD. The cumulative body of data showed that ADHD medications cause modest elevations in resting heart rate and blood pressure. Other adverse effects reported with ADHD stimulants included arrhythmia, nonischemic cardiomyopathy, Takotsubo cardiomyopathy, and sudden death. However, such reports did not imply causation, and there was a paucity of randomized trial evidence addressing long-term safety of ADHD medications, particularly among adults. Further studies are essential to clarify the risks and benefits of ADHD stimulant medications and to explore nonpharmacological options, including regular exercise and omega-3 fatty acids, which could be helpful for improving ADHD symptoms.
- amphetamine salts
- attention-deficit/hyperactivity disorder
- sudden death
Dr. O’Keefe has a major ownership interest in CardioTabs. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received December 4, 2019.
- Revision received May 21, 2020.
- Accepted May 26, 2020.
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