ADHD Medications Lead to Higher Risk of Cardiovascular Disease, According to New Study From Saint Luke’s Cardiologist James O’Keefe, MD

August 13, 2020
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Attention Deficit/Hyperactivity Disorder (ADHD) is a mental health disorder that causes people to have trouble focusing on a single task for long periods of time and struggle to sit still. It is the most commonly diagnosed and medication-treated behavioral disorder in children and adolescents.

Even though the prevalence of ADHD has been stable for the past 30 years, the use of prescription drugs to treat the disorder has increased significantly. Currently, 6.1 million U.S. children and adolescents are taking FDA-approved stimulants for ADHD. According to a study co-authored by Saint Luke’s Mid America Heart Institute cardiologist James O’Keefe, MD, these medications give patients an increased risk of cardiovascular events such as heart attack and stroke and should only be prescribed after nondrug options have been tried.

 “The percentage of people taking ADHD medication is now higher in North America than in Europe or Asia,” O’Keefe said. “The reasons for this could include greater familiarity with medications among practitioners, or the effects of school personnel recommending that parents with kids who struggle academically have them evaluated for ADHD.”

The total body of data O’Keefe and his fellow researchers found showed that ADHD medications cause modest elevations in heart rate and blood pressure. The stimulants have been shown to affect the nervous system by decreasing heart rate variability and stiffening the arteries. ADHD medications already come with warnings on their package inserts regarding potential cardiovascular effects. O’Keefe says because of these risks, nondrug therapies should be the first line of treatment for ADHD before prescription medication.

“Exercise and Omega-3 fatty acids should be tried before any medication,” O’Keefe said. “They both have immediate and long-term behavioral and mental effects in patients with ADHD because they increase good hormones like dopamine and norepinephrine and help to reduce inattentiveness and hyperactivity. Studies have seen improvements in attention, motor skills, and academic performance from nondrug therapies like these.”

An analysis of 10 clinical trials reported that ADHD medications significantly increased resting heart rate by 5.7 beats per minute, which is positively correlated with higher rates of cardiovascular disease. Older patients were far more likely to have new heart failure than younger patients, and to have it more quickly than younger patients after taking ADHD medication.

“More research will need to be done to further clarify the risks and benefits of ADHD stimulant medications,” O’Keefe said, “but we can conclude from what we found here that it’s healthier and safer to use other therapeutic methods, like exercise and fish oil, to treat ADHD besides medication. The most important thing about exercise is it should feel like fun, even if it’s something as simple as bowling or golfing. For fish oil, I recommend taking between 500 and 4,000 milligrams per day.”

Read the full article in the Journal of the American College of Cardiology.

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