Li Lin, Chang Zheng, Sun Jiangwei, Garcia-Argibay Miguel, Du Rietz Ebba, Dobrosavljevic Maja, Brikell Isabell, Jernberg Tomas, Solmi Marco, Cortese Samuele, Larsson Henrik
School of Medical Sciences, Örebro University, Örebro, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
World Psychiatry. 2022 Oct;21(3):452-459. doi: 10.1002/wps.21020.
Accumulating evidence suggests a higher risk for cardiovascular diseases among individuals with mental disorders, but very little is known about the risk for overall and specific groups of cardiovascular diseases in people with attention-deficit/hyperactivity disorder (ADHD). To fill this knowledge gap, we investigated the prospective associations between ADHD and a wide range of cardiovascular diseases in adults. In a nationwide population-based cohort study, we identified 5,389,519 adults born between 1941 and 1983, without pre-existing cardiovascular diseases, from Swedish registers. The study period was from January 1, 2001 to December 31, 2013. Incident cardiovascular disease events were identified according to ICD codes. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards regression model, with ADHD as a time-varying exposure. After an average 11.80 years of follow-up, 38.05% of individuals with ADHD versus 23.57% of those without ADHD had at least one diagnosis of cardiovascular disease (p<0.0001). ADHD was significantly associated with increased risk of any cardiovascular disease (HR=2.05, 95% CI: 1.98-2.13) after adjusting for sex and year of birth. Further adjustments for education level, birth country, type 2 diabetes mellitus, obesity, dyslipidemia, sleep problems and heavy smoking attenuated the association, which however remained significant (HR=1.84, 95% CI: 1.77-1.91). Further adjustment for psychiatric comorbidities attenuated but could not fully explain the association (HR=1.65, 95% CI: 1.59-1.71). The strongest associations were found for cardiac arrest (HR=2.28, 95% CI: 1.81-2.87), hemorrhagic stroke (HR=2.16, 95% CI: 1.68-2.77), and peripheral vascular disease/arteriosclerosis (HR=2.05, 95% CI: 1.76-2.38). Stronger associations were observed in males and younger adults, while comparable associations were found among individuals with or without psychotropic medications and family history of cardiovascular diseases. These data suggest that ADHD is an independent risk factor for a wide range of cardiovascular diseases. They highlight the importance of carefully monitoring cardiovascular health and developing age-appropriate and individualized strategies to reduce the cardiovascular risk in individuals with ADHD.
越来越多的证据表明，患有精神障碍的个体患心血管疾病的风险更高，但对于注意力缺陷多动障碍（ADHD）患者患心血管疾病的总体风险以及特定类型心血管疾病的风险，我们知之甚少。为了填补这一知识空白，我们调查了ADHD与成年人多种心血管疾病之间的前瞻性关联。在一项基于全国人口的队列研究中，我们从瑞典登记处识别出5389519名出生于1941年至1983年之间、无既往心血管疾病的成年人。研究期间为2001年1月1日至2013年12月31日。根据国际疾病分类（ICD）编码确定心血管疾病事件。使用Cox比例风险回归模型计算风险比（HR）及95%置信区间（CI），将ADHD作为随时间变化的暴露因素。经过平均11.80年的随访，患有ADHD的个体中有38.05%至少被诊断出患有一种心血管疾病，而未患ADHD的个体中这一比例为23.57%（p<0.0001）。在调整性别和出生年份后，ADHD与患任何心血管疾病的风险显著增加相关（HR=2.05，95%CI：1.98 - 2.13）。进一步调整教育水平、出生国家、2型糖尿病、肥胖、血脂异常、睡眠问题和大量吸烟后，这种关联有所减弱，但仍然显著（HR=1.84，95%CI：1.77 - 1.91）。进一步调整精神疾病共病情况后，关联减弱但不能完全解释这种关联（HR=1.65，95%CI：1.59 - 1.71）。发现与心脏骤停（HR=2.28，95%CI：1.81 - 2.87）、出血性中风（HR=2.16，95%CI：1.68 - 2.77）和外周血管疾病/动脉硬化（HR=2.05，95%CI：1.76 - 2.38）的关联最强。在男性和年轻成年人中观察到更强的关联，而在使用或未使用精神药物以及有或无心血管疾病家族史的个体中发现了类似的关联。这些数据表明，ADHD是多种心血管疾病的独立危险因素。它们强调了仔细监测心血管健康以及制定适合年龄和个性化的策略以降低ADHD患者心血管风险的重要性。
