Short term use of Methylphenidate for ADHD not fraught with CV risks: JAMA

According to an original investigation on Psychiatry published in JAMA Network Open, Methylphenidate-treated individuals had a 10% higher cardiovascular event rate than non-treated controls in the six months after treatment. No substantial difference (≥20%) or difference based on preexisting cardiovascular disease was observed.

Previous studies have pinpointed safety concerns of medicines for managing ADHD with mixed evidence on possible cardiovascular risk. This study assessed whether short-term methylphenidate use is associated with the risk of cardiovascular events.

This retrospective cohort study analyzed Swedish registry data for individuals with ADHD aged 12-60 who were prescribed methylphenidate between January 1, 2007, and June 30, 2012. Participants were matched with up to 10 non-ADHD controls on birth date, sex, and county. Statistical analyses were conducted from September 13, 2022, to May 16, 2023. Rates of cardiovascular events one year before methylphenidate treatment and six months after treatment initiation were compared between individuals receiving methylphenidate and matched controls using a Bayesian within-individual design.

Key findings from the study are:

• The overall incidence of cardiovascular events was 1.51 per 10,000 person-weeks for individuals receiving methylphenidate and 0.77 for the matched controls.

• Those treated with methylphenidate had an 87% posterior probability of having a higher rate of cardiovascular events after treatment initiation than matched controls.

• The posterior probabilities were 70% for at least a 10% increased risk of cardiovascular events in individuals receiving methylphenidate vs 49% in matched controls.

• No difference was found in this risk between individuals with and without a history of cardiovascular disease.

Concluding further, they said that those receiving methylphenidate had a slightly increased cardiovascular risk compared to matched controls in the six months following treatment initiation.

The study highlighted that methylphenidate use for short-term treatment should not be discontinued due to small cardiovascular risks. Instead, individualized risk-benefit assessments and ongoing risk monitoring are necessary.

Further reading:

Garcia-Argibay M, Bürkner P, Lichtenstein P, et al. Methylphenidate and Short-Term Cardiovascular Risk. JAMA Netw Open. 2024;7(3):e241349. doi:10.1001/jamanetworkopen.2024.1349