View Full Version : ADHD Drugs May Up Risk of Heart Problems in Kids?


TheOrange
07-06-14, 06:33 PM
For parents who are interested:

http://health.usnews.com/health-news/articles/2014/07/03/adhd-drugs-may-up-risk-of-heart-problems-in-kids-study-finds

Just for the record, of course we shouldn't underestimate the effects of heart diseases, they're very serious. But also don't forget that as the study shows, it's rare. We shouldn't jump to conclusions just yet.

For the comparison: In Aspirin instruction leaflets it is stated that there is a rare chance side effects could be haemorrhages, and thousands of them are still taken every day.

Stay aware, and hopefully more study will create a more clear look on this rather worrisome matter.

sarahsweets
07-07-14, 04:40 AM
The new study, published online recently in the Journal of Child and Adolescent Psychopharmacology,[quote] followed 714,000 children in Denmark, born from 1990 to 1999, for an average of 9.5 years. Of those, 8,300 were diagnosed with ADHD after age 5.
Honestly, I have never heard of such an extensive study. As far as I know part of the reason this issue exists in the scientific community is because there hasnt been any real long term studies of stimulants in children and most studies that claim to have monitored a large group of children havent followed standard basics for such theories. I am not saying this is the case with this study, just that I have never seem something like this before. This study should be able to be replicated by other scientists in order for it to be relevant beyond what the author claims.
Of the total with ADHD, 111 kids -- or a little more than 1 percent -- had a heart problem such as high blood pressure, cardiac arrest, irregular heartbeat or general cardiovascular disease.

When the researchers adjusted their statistics to take into account certain differences, they found those who took methylphenidates such as Ritalin or Concerta -- whether diagnosed with ADHD or not -- were about twice as likely to suffer from heart problems.

Certain differences are endless. What kind of differences? The article doesnt say which ones. If there are children with obesity or diabetes in the study, then this would affect the results. Did they also do the same study with regard to amphetamines?So many conditions would need to be considered before making such claims about such a large amount of kids. What kind of a control group did they use? Can this same thing be replicated by other scientists?
These are the types of things I wonder.

MADD As A Hatte
07-07-14, 07:20 AM
For parents who are interested:.

Thanks for this. I am an interested parent, with limited time, in between managing school schedules etc. Could you possibly take a minute to, in bullet point, outline exactly what it is you wish us to stay aware of.

Amtram
07-07-14, 04:50 PM
If you have congenital heart disease, then taking stimulants increases the risk of heart problems. This study is just confirming what we already know. However, the statistical relevance is a lot more striking than the real numbers. 1% of all the kids studied had heart problems, and they were the ones they studied.
"The most common cardiac effects are benign -- very small, clinically insignificant increases in heart rate or blood pressure," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York in New Hyde Park.


Alarms sounded because of reports of sudden deaths, heart attack and stroke related to ADHD drugs, which has led some physicians to assess heart health before starting young people on the drugs.


But a 2011 study of U.S. children and young adults published in the New England Journal of Medicine found no link between ADHD drugs and heart attacks, sudden death and stroke. And in 2012, a study in the Journal of the American Medical Association found no sign of a link in young and middle-aged adults either.


So really, this study does not show that the medications increase risk of heart problems, because it doesn't compare children with heart problems who take stimulants to children with heart problems who don't take stimulants. The heart risk is already there, and the events have not been life-threatening, or anything that would be unexpected even if no medications were involved.

As is common in popular media, the headline is there for clickbait, and the content almost contradicts the headline.

Stevuke79
07-07-14, 05:07 PM
THE ORANGE - good for you for doing research and staying informed. I think after a while you start to recognize articles like these which have a clear disconnect between the title, the hype, and what the cited studies have actually said. (A few have already pointed out the discrepancies here)

All the referenced studies have shown is that there is no statistical relationship between ADHD medications and significant heart problems. There has been evidence of minor heart concerns and so the studies themselves suggest that a doctor should consider existing heart problems or history when prescribing. Then they say, "Research is still being done". Which in the article implies that we think there may be risks but we're not 100% sure - when the truth is the opposite interpretation.

HADDaball
07-07-14, 11:54 PM
Maybe things need to be kept in perspective.

For example, a stimulant treated child's heart attack risk may double from 1% to 2%. It may still be low overall.

Keep in mind, there may be vested interests. It may not be true in this case, but company supported academic fraud relating to medicines is known to be an issue.

For me, I'd rather know the truth about all the benefits and drawbacks, so an informed decision can be made.

Sounds like more research is needed.

HADDaball
07-08-14, 05:15 PM
It might be handy to let the child know. Like if they feel side effects, like feeling funny in the chest etc, they must tell the parent.

They may not know how to read the signs something's wrong.

Stevuke79
07-08-14, 05:30 PM
That's important HADDaball; agreed.

Just so we're clear, that's basic prescribing and medication management. Account for existing conditions, family history and monitor side effects particularly cardiovascular. It relates to what you said earlier: Studies have been done and time and again show no statistically significant connection to non-insignificant heart issues, but these are stimulants and we're prescribing to children so it continues to be studied and reviewed.

I'm pointing this out because it is different than a study raising a concern. Just the opposite has happened here, we had a concern, we've been studying it and have consistently show these meds to be safe. The difference is important, which is why the article is disingenuous.

HADDaball
07-09-14, 07:17 PM
It does make me wonder a bit when exercising.

The risks could go up if you're running and dehydrated.

It's in the back of my mind. Like if I feel chest pain running to back off.

My concern is more for adults.

Like, kids cardiovascular systems haven't aged much.

But adults tend to get heart disease and stiff blood vessels as they age.

Has there been any long term studies where people have taken Ritalin for over 30 years and seen how their heart health is?

HADDaball
07-11-14, 08:06 PM
here's a link to the study:

http://mit.econ.au.dk/vip_htm/hnielsen/documents/cardio.pdf

I find it interesting the most common event was arrhythmia.

Could methylphenidate group medicines contribute to heart rythym problems when taken long term?

Amtram
07-12-14, 05:07 PM
No, the study didn't show that. The kids with arrythmia had it as a pre-existing condition.

HADDaball
07-15-14, 10:24 PM
Are you sure ?


...
Stimulant use versus non-use
in the national population

Among 714,258 subjects (6,767,982 person-years), with each
subject contributing with a mean of 9.5 years of observation, a total
of 5734 individuals had a cardiovascular event (84 events per
100,000 person-years). There was an increased risk of any car-
diovascular event in stimulant users compared with non-users in the
total population, with an adjusted HR of 1.83 (95% CI 1.10–3.04).


Use of stimulants versus non-use
in subjects with ADHD

Among children with ADHD (n = 8,300) we identified 111 car-
diovascular events (170 events per 100,000 person-years). In
children with ADHD, stimulant use versus non-use was associated
with an increased hazard for a cardiovascular event (adjusted
HR = 2.34 [1.15–4.75]). The 111 cardiovascular events in children
with ADHD included hypertension (8%), ischemic heart disease
(2%), pulmonary heart disease ( < 1%), arrhythmias (23%), ...

(p. 3)
From what I understand, the hazard risk for cardiac events in stimulant users is 2.34 times more likely than non stimulant users (for ADHD children) and 1.84x more likely in the normal child population.

I may have missed something, but didn't see any linked comment with preexisting conditions.

?

HADDaball
07-15-14, 10:57 PM
...

Looking at it generally, kids having heart events is rare.

Though, it still makes sense to have heart checks before stimulant trials.

Amtram
07-16-14, 09:12 PM
It's in there about the pre-existing conditions.

Flory
07-16-14, 09:38 PM
Not medicating poses other psychological, socio economic risks that place you in a direct line for making poor lifestyle choices which by virtue expose you to a whole host of health and social problems (std's,imprisonment, teen pregnancy, mental illness, low achievement, relationship problems etc)

Barkley found that people with ADHD had higher levels of arterial plaque than their nt counterparts as a direct result of some of the poor lifestyle choices correlating to this disorder.

Also with the territory of unmedicated and under treated ADHD do you find various self medicating behaviours and drug addiction both illegal and other types. So so so common even just on addf (as well as all the literature that supports this) to hav stories of people that are addicts or former addicts

I just think it's important that this is out there too! Nobody is out on drugs without considering the pros and cons, it's when the cons are far outweighed by the positives and avoidane of much more frightening and damaging outcomes that we can say it's a good idea to use meds

Kunga Dorji
07-23-14, 07:03 PM
[quote]The new study, published online recently in the Journal of Child and Adolescent Psychopharmacology,
Honestly, I have never heard of such an extensive study. As far as I know part of the reason this issue exists in the scientific community is because there hasnt been any real long term studies of stimulants in children and most studies that claim to have monitored a large group of children havent followed standard basics for such theories. I am not saying this is the case with this study, just that I have never seem something like this before. This study should be able to be replicated by other scientists in order for it to be relevant beyond what the author claims.


Certain differences are endless. What kind of differences? The article doesnt say which ones. If there are children with obesity or diabetes in the study, then this would affect the results. Did they also do the same study with regard to amphetamines?So many conditions would need to be considered before making such claims about such a large amount of kids. What kind of a control group did they use? Can this same thing be replicated by other scientists?
These are the types of things I wonder.

Sarah, the study was a long term review of health outcomes of ALL children in that age cohort in Denmark- so the concept of using a control group does not apply.

What the study did not show was an increase in serious cardiovascular events ( the serious ones listed occurred at an extremely low rate- maybe 1-2 cases in the whole group).
Nor did it show a breakdown of the non serious events.
We already know perfectly well that there is an increased incidence of high blood pressure and raised heart rate on stimulants- and that part of their effect is achieved by increasing cerebral blood flow.
The above 2 side effects are managed routinely within the context of managing stimulant medication and if problematic, the medication is stopped.

The risk of significant side effects overall is very very low- far lower than say penicillins.

HADDaball
08-16-14, 08:03 PM
...
What the study did not show was an increase in serious cardiovascular events ...


With all due respect, the study suggests the opposite - over twice as many cardiovascular events

84 /100,000 person-years total (child) pop.
vs.
174 / 100,000 p-y with stimulant treated ADHD children

(p. 3)
It showed risks of them more than doubled (x2.2) with stimulant treated ADHD kids:


RESULTS:
...
In children with ADHD (n = 8300) stimulant treatment also increased
the risk of a cardiovascular event (adjusted HR = 2.20 [2.15–2.24]), with a complex time-dependent dose-response relationship.

(p.1)

It also showed increased risks taking methylphenidate with a clear dose-response relationship over the longest measured time span (12 months), with the highest dose being significant:


...
Stimulant dosage 12 months before the adverse cardiovascular
event (n = 8295)
Non-user (reference) 1
Dosage < 15 mg methylphenidate
1.43
0.57 3.59
Dosage 15–30 mg methylphenidate
1.67
0.84 3.32
Dosage > 30 mg methylphenidate
2.24
1.20 4.21

-------------
Bold indicates a significantly increased hazard ratio compared to the
reference group.
...
(p. 7)

daveddd
08-16-14, 08:33 PM
Cause and correlation can be deceiving.

I wonder if a history of mitral valve prolapse was accounted for

A condition common in disorders that often lead to ADHD

HADDaball
08-16-14, 11:02 PM
Apologies Kunga.. suffering 'foot in mouth' lately :)

The study didn't find significant rises in stimulant treated ADHD kids of serious cardiac events (sudden death, heart attack, stroke).

Yeah daveddd. There's lots of things that could be looked into to establish baselines before treatment. There's so much to know and doing good research is challenging.