哌醋甲酯的使用与普通人群中心外心脏骤停的风险增加相关：一项全国范围内的巢式病例对照研究。

Use of methylphenidate is associated with increased risk of out-of-hospital cardiac arrest in the general population: a nationwide nested case-control study.

机构信息

Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark.

Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands.

出版信息

Eur Heart J Cardiovasc Pharmacother. 2023 Nov 2;9(7):658-665. doi: 10.1093/ehjcvp/pvad028.

DOI:10.1093/ehjcvp/pvad028

Abstract

AIM

Methylphenidate, a sympathomimetic drug prescribed to treat attention-deficit/hyperactivity disorder (ADHD), is associated with cardiovascular events, but few studies have explored the risk of out-of-hospital cardiac arrest (OHCA). We investigated whether methylphenidate use is associated with OHCA in the general population.

METHODS AND RESULTS

Using Danish nationwide registries, we conducted a nested case-control study with OHCA cases of presumed cardiac causes and age/sex/OHCA-date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the odds ratio (OR) of OHCA by comparing methylphenidate use with no use of methylphenidate.The study population consisted of 46 578 OHCA cases [median: 72 years (interquartile range: 62-81), 68.8% men] and 232 890 matched controls. Methylphenidate was used by 80 cases and 166 controls, and was associated with an increased OR of OHCA compared with non-users {OR: 1.78 [95% confidence interval (CI): 1.32-2.40]}. The OR was highest in recent starters (OR≤180 days: 2.59, 95% CI: 1.28-5.23). The OR of OHCA associated with methylphenidate use did not vary significantly by age (P-value interaction: 0.37), sex (P-value interaction: 0.94), and pre-existing cardiovascular disease (P-value interaction: 0.27). Furthermore, the ORs remained elevated when we repeated the analyses in individuals without registered hospital-based ADHD (OR: 1.85, 95% CI: 1.34-2.55), without severe psychiatric disorders (OR: 1.98, 95% CI: 1.46-2.67), without depression (OR: 1.93, 95% CI: 1.40-2.65), or in non-users of QT-prolonging drugs (OR: 1.79, 95% CI: 1.27-2.54).

CONCLUSION

Methylphenidate use is associated with an increased risk of OHCA in the general population. This increased risk applies to both sexes and is independent of age and the presence of cardiovascular disease.

摘要

目的

哌醋甲酯是一种拟交感神经药物，用于治疗注意力缺陷多动障碍（ADHD），与心血管事件相关，但很少有研究探讨其与院外心脏骤停（OHCA）的风险。我们研究了哌醋甲酯的使用是否与普通人群中的 OHCA 有关。

方法和结果

使用丹麦全国性登记处，我们对 OHCA 病例（假定为心脏原因）和普通人群中年龄/性别/OHCA 日期匹配的非 OHCA 对照进行了嵌套病例对照研究。使用调整了 OHCA 已知危险因素的条件逻辑回归模型，比较了哌醋甲酯使用者与未使用者的 OHCA 比值比（OR）。研究人群包括 46578 例 OHCA 病例[中位数：72 岁（四分位距：62-81），68.8%为男性]和 232890 例匹配对照。80 例病例和 166 例对照使用了哌醋甲酯，与未使用者相比，哌醋甲酯使用者发生 OHCA 的 OR 增加{OR：1.78[95%置信区间（CI）：1.32-2.40]}。在最近开始使用哌醋甲酯的患者中（使用≤180 天：2.59，95%CI：1.28-5.23），OR 最高。哌醋甲酯使用与 OHCA 相关的 OR 不因年龄（P 值交互作用：0.37）、性别（P 值交互作用：0.94）和预先存在的心血管疾病（P 值交互作用：0.27）而异。此外，当我们在未登记的医院 ADHD 患者中重复分析（OR：1.85，95%CI：1.34-2.55）、无严重精神疾病（OR：1.98，95%CI：1.46-2.67）、无抑郁（OR：1.93，95%CI：1.40-2.65）或未使用 QT 延长药物的患者（OR：1.79，95%CI：1.27-2.54）中，OR 仍然升高。