Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, No. 38 Dengzhou Road, Shibei District, Qingdao, 266021, Shandong Province, China.
Department of Geriatric Internal Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
Eur Child Adolesc Psychiatry. 2019 Oct;28(10):1283-1293. doi: 10.1007/s00787-018-1217-x. Epub 2018 Aug 24.
This meta-analysis was conducted to evaluate the association between Attention deficit hyperactivity disorder (ADHD) medications and risk of sudden death/arrhythmia, stroke, myocardial infarction as well as all-cause death. We searched PubMed, Web of Science and China National Knowledge Infrastructure from 1950 to May 2018. All observational studies that the exposure of interest was ADHD medications, the outcome of interest was sudden death/arrhythmia, stroke, myocardial infarction as well as all-cause death, and the study reported relative risks (RRs) with 95% confidence intervals (95% CIs) were included. Pooled RRs were estimated by random-effects model. Subgroup analyses were conducted to examine the effects of study design, population, Country, follow-up duration, female proportion, covariates adjustment on the risk of sudden death/arrhythmia. Eight articles with ten studies (4,221,929 participants) were included in this meta-analysis about the association between ADHD medications and risk of sudden death/arrhythmia. The pooled RRs with 95% CIs of sudden death/arrhythmia for ADHD medications were 1.39 (1.06, 1.83). The result of the cohort study was 1.24 (0.84, 1.83). The pooled RRs between ADHD medications and stroke, myocardial infarction, all-cause death were 1.00 (0.74, 1.35), 0.91 (0.79, 1.05), 0.89 (0.54, 1.45), respectively. As for methylphenidate, the pooled RRs between methylphenidate and sudden death/arrhythmia, stroke, myocardial infarction, all-cause death were 1.46 (1.03, 2.07), 0.92 (0.70, 1.21), 0.97 (0.77, 1.23), 1.00 (0.49, 2.04), respectively. Based on the results of cohort studies, there was no correlation between ADHD medications and sudden death/arrhythmia, stroke, myocardial infarction and all-cause death. However, some of the confidence intervals do not exclude modest elevated risks, e.g., for sudden death/arrhythmia.
这项荟萃分析旨在评估注意力缺陷多动障碍（ADHD）药物与猝死/心律失常、中风、心肌梗死以及全因死亡风险之间的关联。我们检索了 1950 年至 2018 年 5 月的 PubMed、Web of Science 和中国国家知识基础设施（CNKI）。纳入的研究为观察性研究，其暴露因素为 ADHD 药物，结局因素为猝死/心律失常、中风、心肌梗死和全因死亡，且研究报告了相对风险（RR）及其 95%置信区间（95%CI）。采用随机效应模型估计汇总 RR。进行亚组分析以检验研究设计、人群、国家、随访时间、女性比例、协变量调整对猝死/心律失常风险的影响。关于 ADHD 药物与猝死/心律失常风险之间关联的这项荟萃分析纳入了 8 篇文章中的 10 项研究（4221929 名参与者）。ADHD 药物与猝死/心律失常风险的汇总 RR（95%CI）为 1.39（1.06，1.83）。队列研究的结果为 1.24（0.84，1.83）。ADHD 药物与中风、心肌梗死和全因死亡之间的汇总 RR 分别为 1.00（0.74，1.35）、0.91（0.79，1.05）和 0.89（0.54，1.45）。对于哌甲酯，哌甲酯与猝死/心律失常、中风、心肌梗死和全因死亡的汇总 RR 分别为 1.46（1.03，2.07）、0.92（0.70，1.21）、0.97（0.77，1.23）和 1.00（0.49，2.04）。基于队列研究的结果，ADHD 药物与猝死/心律失常、中风、心肌梗死和全因死亡之间无相关性。然而，部分置信区间并未排除适度升高的风险，例如猝死/心律失常。
