Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Eur Neuropsychopharmacol. 2013 Jun;23(6):534-41. doi: 10.1016/j.euroneuro.2012.06.011. Epub 2012 Jul 15.
Compared to children, adults with ADHD are at greater risk for developing adverse cardiovascular related outcomes and, if treated, may be likely to carry a greater burden of exposure to stimulant medications. The goal of this report is to critically review the available literature relevant to the cardiovascular safety of CNS stimulants for adult ADHD (aADHD). Twenty potential clinical trials of a CNS stimulant for aADHD have been published between 1979 and 2012. Of these, ten presented sufficient data to estimate the relative change in various cardiovascular parameters associated with ADHD treatment modalities. These trials were predominantly focused on long-acting stimulant preparations for acute symptom reduction (median duration=6 weeks, range: 4-24 weeks) and enrolled relatively young subjects (median age=36 years, range: 22-40). Using random effects meta-analysis, we found that subjects randomized to CNS stimulant treatment demonstrated a statistically significant increased resting heart rate [+5.7bpm (3.6, 7.8), p<0.001] and systolic blood pressure findings [+2.0mmHg (0.8, 3.2), p=0.005] compared with subjects randomized to placebo. There was a statistically significant increased risk for a resting heart rate >90bpm [4.2% (n=50) vs. 1.7% (n=8), OR=2.75 (1.3, 6.7), p=0.006] associated with CNS stimulant treatment. In light of prognostic value of resting heart rate with regard to cardiovascular morbidity in epidemiological studies, future research of adults with ADHD should focus on the potential clinical impact of the increase in heart rate observed in this meta-analysis.
与儿童相比，患有 ADHD 的成年人发生不良心血管相关结局的风险更高，而如果接受治疗，他们可能会暴露于兴奋剂药物的风险更大。本报告的目的是批判性地回顾与成人 ADHD（aADHD）中枢神经系统兴奋剂心血管安全性相关的现有文献。自 1979 年至 2012 年，已经发表了 20 项关于 aADHD 中枢神经系统兴奋剂的潜在临床试验。其中，有 10 项提供了足够的数据来估计与 ADHD 治疗方式相关的各种心血管参数的相对变化。这些试验主要集中在长效兴奋剂制剂的急性症状缓解（中位持续时间=6 周，范围：4-24 周）和相对年轻的受试者（中位年龄=36 岁，范围：22-40 岁）。使用随机效应荟萃分析，我们发现与随机分配到安慰剂的受试者相比，随机分配到中枢神经系统兴奋剂治疗的受试者静息心率[增加 5.7bpm（3.6，7.8），p<0.001]和收缩压的发现[增加 2.0mmHg（0.8，3.2），p=0.005]有统计学意义。与中枢神经系统兴奋剂治疗相关的静息心率>90bpm 的风险增加有统计学意义[4.2%（n=50）与 1.7%（n=8），OR=2.75（1.3，6.7），p=0.006]。鉴于静息心率在流行病学研究中对心血管发病率的预后价值，未来对 ADHD 成年人的研究应重点关注该荟萃分析中观察到的心率增加对临床的潜在影响。
