Stimulants and the Heart - ADHD and Cardiovascular Risks

Main Chapters:
00:00 Intro - Stimulants and the Heart
00:14 Take home message
01:41 Why Focus on Cardiovascular Issues?
08:26 Studies on Stimulants and Cardiovascular Issues
16:24 How to Prevent Potential Cardiovascular Issues
22:10 Conclusion
23:39 Questions

Medications, particularly stimulants, remain the best documented and most potent treatments for ADHD. But we know that many of our medications, including forms of amphetamine (Adderall, Vyvanse), methylphenidate (Ritalin, Concerta), atomoxetine (Strattera), and bupropion (Wellbutrin) increase blood pressure and heart rate slightly in the first weeks and months of treatment.

A 2022 meta-analysis of almost four million patients failed to find negative cardiac health impacts from ADHD medications. But a more recent, longer term study (2-7 years), comparing those with ADHD and cardiovascular disease to those with ADHD but no cardiovascular disease, found that ADHD medications were statistically associated with hypertension and arterial disease. Longer use, and higher doses posed the biggest risks. But the medications were not linked to arrhythmias, heart attacks, strokes, heart failure or other serious events with blood clots.

Numerous headlines claimed that the new evidence showed how dangerous ADHD medications are. Although the research has important public health implications, most patients should be reassured by the low risk to any particular individual. Only 4% of the participants had a newly diagnosed cardiovascular condition arise during the years of the study.

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References:
Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases (2023)
https://jamanetwork.com/journals/jama...

Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity Disorder A Systematic Review and Meta-analysis (2022)
https://jamanetwork.com/journals/jama...

Long-term methylphenidate exposure and 24-hours blood pressure and left ventricular mass in adolescents and young adults with attention deficit hyperactivity disorder
https://www.sciencedirect.com/science...

Autonomic and endocrine control of cardiovascular function (2015)
https://www.ncbi.nlm.nih.gov/pmc/arti...

Full Chapter list:
00:00 Intro - Stimulants and the Heart
00:14 Take home message
01:41 Why Focus on Cardiovascular Issues?
03:05 Stimulants and Heart Rate / Arrhythmia
04:47 Stimulants and Arteries / Blood Pressure
07:01 Hypertension
08:26 Studies on Stimulants and Cardiovascular Issues
08:43 Study Showing No Impact of Stimulants
10:19 Study Showing Some Impact of Stimulants
12:58 Study Results
14:36 Study Analysis
16:24 How to Prevent Potential Cardiovascular Issues
16:36 Electrocardiogram (EKG/ECG)
17:36 Blood Pressure Monitoring
19:16 Differences in Medication Types / Formulations / Dosages
21:29 Other ADHD Risk Factors for Cardiovascular Issues
22:10 Conclusion
23:39 Questions
23:53 Blood Pressure Increase with Stimulants and Alternatives
24:43 Hypertensive Medication with Stimulants
25:47 Stress and Depression
26:38 Stimulants Lowering Blood Pressure
27:17 Dealing with Doctors Blaming ADHD Medication
28:56 Stimulants and Stress / Cortisol Levels
30:21 Outro

Streamed live January 31, 2024

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Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions.
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