Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL 32611, USA.
Curr Psychiatry Rep. 2013 Aug;15(8):379. doi: 10.1007/s11920-013-0379-y.
The past decade has seen a heated debate over the cardiac safety of central nervous system stimulants in the treatment of ADHD. This review discusses five controlled population-based studies that investigated this risk in children in the United States. All studies utilized administrative claims data of private or public insurance to compare risk of stimulant use to non-use. Two studies with smaller sample size lacked the ability to investigate serious events but report a slightly increased risk of emergency department visits attributed to cardiac symptoms such as tachycardia or palpitation. Three studies that enrolled more than one million patients found no association between stimulants and composite endpoints of sudden cardiac death, myocardial infarction, stroke and ventricular arrhythmia. The studies concur that background rates of serious cardiovascular events in children are extremely small. No study exceeded an average follow-up of two years, prohibiting inferences about long-term effects of stimulants.
过去十年，中枢神经系统兴奋剂治疗 ADHD 的心脏安全性一直存在激烈争论。本综述讨论了五篇针对美国儿童的对照人群研究，旨在探讨这一风险。所有研究均利用私人或公共保险的行政索赔数据来比较兴奋剂使用与不使用的风险。两项样本量较小的研究无法调查严重事件，但报告称因心动过速或心悸等心脏症状导致急诊就诊的风险略有增加。另外三项纳入超过一百万例患者的研究发现，兴奋剂与心脏性猝死、心肌梗死、中风和室性心律失常的综合终点之间没有关联。这些研究一致认为，儿童严重心血管事件的基础发生率极低。没有研究的平均随访时间超过两年，因此无法推断兴奋剂的长期影响。
