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Do prescription stimulants increase the risk ofadverse cardiovascular events? A systematic review

Do prescription stimulants increase the risk ofadverse cardiovascular events? A systematic review

There is increasing concern that prescription stimulants may be associated with adversecardiovascular events such as stroke, myocardial infarction, and sudden death. Public healthconcerns are amplified by increasing use of prescription stimulants among adults. The objective of this study was to conduct a systematic review of the evidence of anassociation between prescription stimulant use and adverse cardiovascular outcomes.PUBMED, MEDLINE, EMBASE and Google Scholar searches were conducted using keywords related to these topics (MESH): ADHD; Adults; Amphetamine; Amphetamines;Arrhythmias, Cardiac; Cardiovascular Diseases; Cardiovascular System; Central NervousStimulants; Cerebrovascular; Cohort Studies; Case-control Studies; Death; Death, Sudden,Cardiac; Dextroamphetamine; Drug Toxicity; Methamphetamine; Methylphenidate;Myocardial Infarction; Stimulant; Stroke; Safety. Eligible studies were population-basedstudies of children, adolescents, or adults using prescription stimulant use as the independentvariable and a hard cardiovascular outcome as the dependent variable. Ten population-based observational studies which evaluated prescription stimulant use withcardiovascular outcomes were reviewed. Six out of seven studies in children and adolescentsdid not show an association between stimulant use and adverse cardiovascular outcomes. Incontrast, two out of three studies in adults found an association. Findings of an association between prescription stimulant use and adverse cardiovascularoutcomes are mixed. Studies of children and adolescents suggest that statistical power islimited in available study populations, and the absolute risk of an event is low. Moresuggestive of a safety signal, studies of adults found an increased risk for transient ischemicattack and sudden death/ventricular arrhythmia. Interpretation was limited due to differencesin population, cardiovascular outcome selection/ascertainment, and methodology. Accountingfor confounding and selection biases in these studies is of particular concern. Future studiesshould address this and other methodological issues.

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