Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.
Am J Psychiatry. 2012 Feb;169(2):178-85. doi: 10.1176/appi.ajp.2011.11010125.
The authors sought to determine whether use of methylphenidate in adults is associated with elevated rates of serious cardiovascular events compared with rates in nonusers.
This was a cohort study of new users of methylphenidate based on administrative data from a five-state Medicaid database and a 14-state commercial insurance database. All new methylphenidate users with at least 180 days of prior enrollment were identified. Users were matched on data source, state, sex, and age to as many as four comparison subjects who did not use methylphenidate, amphetamines, or atomoxetine. A total of 43,999 new methylphenidate users were identified and matched to 175,955 nonusers. Events of primary interest were 1) sudden death or ventricular arrhythmia, 2) stroke, 3) myocardial infarction, and 4) a composite endpoint of stroke or myocardial infarction.
The age-standardized incidence rate per 1,000 person-years of sudden death or ventricular arrhythmia was 2.17 (95% CI=1.63-2.83) in methylphenidate users and 0.98 (95% CI=0.89-1.08) in nonusers, for an adjusted hazard ratio of 1.84 (95% CI=1.33-2.55). Dosage was inversely associated with risk. Adjusted hazard ratios for stroke, myocardial infarction, and the composite endpoint of stroke or myocardial infarction did not differ statistically from 1.
Although initiation of methylphenidate was associated with a 1.8-fold increase in risk of sudden death or ventricular arrhythmia, the lack of a dose-response relationship suggests that this association may not be a causal one.
作者旨在确定与非使用者相比，成年人使用哌醋甲酯是否与严重心血管事件发生率升高相关。
这是一项基于来自五个州医疗补助数据库和 14 个州商业保险数据库的行政数据的新使用者哌醋甲酯的队列研究。确定了至少有 180 天之前登记的所有新哌醋甲酯使用者。根据数据源、州、性别和年龄，将使用者与多达 4 名未使用哌醋甲酯、安非他命或托莫西汀的对照者相匹配。共确定了 43999 名新哌醋甲酯使用者，并与 175955 名非使用者相匹配。主要关注的事件有 1）突然死亡或室性心律失常，2）中风，3）心肌梗死，以及 4）中风或心肌梗死的综合终点。
年龄标准化发生率为每 1000 人年 2.17（95%CI=1.63-2.83）的突然死亡或室性心律失常在哌醋甲酯使用者中，而非使用者中为 0.98（95%CI=0.89-1.08），调整后的危险比为 1.84（95%CI=1.33-2.55）。剂量与风险呈反比。调整后的中风、心肌梗死和中风或心肌梗死的综合终点的危险比与 1 无统计学差异。
尽管哌醋甲酯的起始与突然死亡或室性心律失常风险增加 1.8 倍相关，但缺乏剂量反应关系表明，这种关联可能不是因果关系。
