Is There A Link Between ADHD And Heart Disease?

Attention deficit hyperactivity disorder (ADHD) is a behavioral problem affecting about 8-10% of children.  The complicated name comes from the fact that children are affected by it in more than one way – having a variable combination of hyperactivity, impulsive behavior and lack of attention.  Three different subtypes of the disorder are recognised: mostly hyperactive and impulsive; mostly inattentive or a combination of all three behaviors. 

The condition generally affects boys more than girls, with the subtype where hyperactivity predominates being four times more common in boys than girls, but the inattentive subtype is only twice as common in boys. There are specific criteria for a clinical diagnosis of ADHD which a psychiatrist or psychologist would carry out on a child suspected of having the disorder. 

Looking after children with ADHD can be very challenging, and deprive siblings and classmates of attention.  And although considered to be a childhood disorder, symptoms of ADHD can sometimes persist into  adult life, hampering personal relationships, while lack of concentration reduce employment opportunities.

ADHD has been linked with psychiatric conditions such as depression and other medical conditions such as congenital (inborn) heart defects. This is because babies born with heart defects may suffer lack of oxygen to the brain as a result of the condition, or of surgery to repair it.

The most common type of drug treatment, taken by about 3% of children in the US, is with medicines which stimulate the nervous system. These stimulant drugs can boost and balance the levels of chemical ‘messengers’ within the brain, called neurotransmitters.  They include the drug methylphenidate in branded drugs such as Concerta, Daytrana, Metadate, Methylin, Ritalin, and Focalin; and amphetamines, as in Dexedrine, Dextrostat, Vyvanse, Adderall, and Desoxyn.  Children vary in the doses needed of these drugs, and in their response to them. Some children will be dramatically changed by drug treatment, improving both their lives and of those around them – family, friends and teachers.  

It is well-known that the stimulant drugs used in ADHD, commonly raise heart rate and blood pressure. But between January 1992 and February 2005 the Food and Drug Administration (FDA) which monitors drug safety, reported 11 sudden deaths in children taking stimulant medication for treatment of ADHD.  This rang ‘alarm bells’ although this rate of sudden deaths is the same as would be seen in the general population, over the same period.  A study published in 2009 in the American Journal of Psychiatry looked into whether the concerns were justified. It reported a higher incidence of sudden unexplained death in children, aged 7-19, taking stimulant drugs for ADHD. But the doctors involved in this study admitted that there were a number of significant limitations to the study and that it was not large enough to prove a link between ADHD medication and sudden death.

So Is There A Link Between ADHD Medication And Heart Disease?

Since the 2009 study the FDA commissioned three more studies, the latest of which was published in 2012.  

The study leader, Dr Mark Olfson, MD, MPH, professor of clinical psychiatry at Columbia University College of Physicians & Surgeons, and New York State Psychiatric Institute of Columbia University said: ‘Our findings should help alleviate the fears many parents have about stimulants’.  The two-year study compared data from a number of private health insurance companies, looking for a link between taking stimulant drugs and heart events. 

They found that only one of the 170,000 cases examined had a serious heart event, and that the rate of serious cardiac events was no different among those taking simulant drugs than in the general population.  Also less serious events such as arrhythmias (irregular heart rhythms) and angina (chest pain), were not seen any more frequently in those taking stimulant drugs.  

Does this mean ADHD drugs are safe for all children?

This was intentional as those children would be more likely to have a cardiac event – whether or not they took stimulant drugs – and so would artificially bias the results.  Also, it is well-known that stimulant drugs can raise blood pressure and heart rate in some people, which could make a person with a heart condition more likely to suffer a serious event, such as a heart attack.

Should stimulant drugs be avoided in children with heart conditions?

Yes, is the current advice.  The FDA recommends that stimulant drugs are avoided by people with serious heart problems, or if an increase in heart rate or blood pressure would cause health issues.  

While confirming that both patients and parents can be reassured by the outcome of his study, Dr Olfson says: ‘physicians should carefully examine the patient and take a thorough family history of heart disease before prescribing stimulants, because stimulant use is linked to serious events in children with pre-existing heart conditions.

As well as asking about a family history of heart conditions, a prescribing physician will also want to know of any family history of sudden unexplained death.

What about non-stimulant drugs for ADHD?

Atomoxetine (Strattera) is an ADHD drug, not classified as stimulant, but the FDA has included it in the warnings i.e. it is not recommended in people with heart conditions.

If you have any concerns about your child’s health or their medication, consult your doctor.