• A large population-based study in Sweden recently showed that people with attention deficit hyperactivity disorder (ADHD) had twice the risk of all types of cardiovascular disease than those without ADHD.
  • Among adults with ADHD, men, young people, and people with comorbid psychiatric conditions were at increased cardiovascular risk.
  • Study highlights the importance of monitoring people with ADHD for cardiovascular risk and developing targeted strategies to reduce their risk of cardiovascular disease.

There is growing evidence to suggest a link between mental health disorders and cardiovascular disease (CVD risk. Yet there is little evidence to suggest a similar association between attention deficit hyperactivity disorder (ADHD) and cardiovascular risk.

A recent national study published in Global Psychiatry shows that people with ADHD had an increased risk of cardiovascular disease compared to those without ADHD, even after controlling for cardiovascular risk factors.

Dr Carl Laviea cardiologist from the University of Queensland Medical School in Australia, not involved in the study, said Medical News Today:

“The study is huge with a long follow-up and even taking into account the potential errors in maintaining such a huge database, the study certainly suggests that ADHD is associated with a possible doubling of CVD risk. Considering that this condition[TDAH]appears to be increasing, along with early drug use and physical inactivity, these data certainly raise red flags regarding long-term CVD risks in this patient population.[ADHD}appearstobeincreasingalongwithearlydruguseandphysicalinactivitythesedatacertainlyraisedflagsregardinglong-termCVDrisksinthispatientpopulation”[ADHD}appearstobeincreasingalongwithearlydruguseandphysicalinactivitythesedatacertainlyraiseredflagsregardinglong-termCVDrisksinthispatientpopulation”

ADHD is a mental health disorder characterized by attention deficits, hyperactivity and increased impulsivity. As one of the most common mental health problems in children, ADHD also affects adults. Worldwide, the prevalence of ADHD in children is 2.2% and 2.5% in adults.

People with ADHD often have co-occurring psychological conditions, such as anxiety and depression, and physical conditions, such as obesity.

Previous studies have shown that various mental health problems, such as autism, anxiety disordersand the Depression, are associated with an increased risk of cardiovascular disease. However, there is little data to suggest an association between ADHD and an increased risk of cardiovascular disease.

There is also a lack of data to determine whether people with ADHD are at increased risk for specific cardiovascular diseases, including stroke, cardiac arrest, arrhythmias, arteriosclerosis and heart failure. Prevention and treatment strategies for different types of cardiovascular disease can vary, making it essential to understand the association between ADHD and different cardiovascular diseases.

Furthermore, the extent to which cardiovascular risk factors in people with ADHD influence the risk of cardiovascular disease in these individuals is not fully understood. Some of the risk factors for cardiovascular disease include:

  • level of education
  • family history of cardiovascular disease
  • sleep problems
  • obesity
  • Diabetes
  • smoking

Due to the prevalence of comorbid psychiatric disorders, people with ADHD receive medication for other mental health disorders concurrently.

Previous studies suggest that drugs used for ADHD and other mental health conditions such as anxiety and depression may increase the risk of cardiovascular disease. Thus, the use of these drugs or the presence of mental health problems could potentially increase the risk of cardiovascular disease in people with ADHD.

Characterizing the impact of cardiovascular risk factors could help early identify people with ADHD at increased risk of cardiovascular disease.

In the current study, the researchers used data on more than 5.4 million Swedish adults born between 1941 and 1983 without a prior diagnosis of cardiovascular disease.

The researchers used Swedish national registers to identify individuals in the study population with an ADHD diagnosis. They also obtained data on other mental health conditions and cardiovascular risk factors, including diabetes, obesity, sleep problems and smoking, from these registries.

Using national health care registries, researchers tracked the occurrence of cardiovascular disease in the study population over a 13-year follow-up period from January 2001 to December 2013. The researchers found that the proportion of individuals who developed cardiovascular disease was higher in people with ADHD than in their counterparts without ADHD.

After controlling for age and sex, the analysis showed that people with ADHD were twice as likely to develop cardiovascular disease as those without ADHD.

Researchers found that cardiovascular risk factors such as excessive smoking, obesity, diabetes, sleep problems, low education, and psychiatric disorders were more common in people with ADHD. Yet controlling these cardiovascular risk factors only slightly weakened the association between ADHD and cardiovascular disease risk.

Additionally, excluding people with ADHD who used medication for ADHD or other mental health conditions also did not influence the strength of the association between ADHD and cardiovascular disease risk.

These results suggest that ADHD, independent of caCardiovascular risk factors such as obesity, smoking and comorbid psychiatric disorders could be a risk factor for cardiovascular disease.

The study also found that ADHD was associated with an increased risk of all types of cardiovascular disease. The strongest association was observed between ADHD and cardiac arrest, hemorrhagic stroke and arteriosclerosis.

The severity of the main ADHD symptoms tends to lessen with age, while the risk of cardiovascular disease increases with age. In addition, ADHD and cardiovascular disease are more common in men than in women.

Therefore, the researchers categorized the study population by age and sex to assess the impact of these factors on the risk of cardiovascular disease in people with ADHD. They found that the association between ADHD and cardiovascular risk was stronger in men than in women and younger individuals than their older counterparts.

In a separate analysis, the researchers found that people with ADHD and co-occurring psychiatric disorders, such as eating disorders and substance use disorders, also had an increased risk of cardiovascular disease than those with people with ADHD only.

The study results suggest that clinicians should monitor the cardiovascular health of people with ADHD early to facilitate the implementation of strategies to reduce cardiovascular risk. Among people with ADHD, young adults, men with ADHD, and those with comorbid psychiatric conditions may be at particularly high risk for cardiovascular disease.

The co-author of the study Henrik Larsson, Ph.D., professor of epidemiology at Örebro University, said in a Press release:

“Clinicians need to carefully consider psychiatric comorbidity and lifestyle factors to help reduce CVD risk in people with ADHD, but we also need more research to explore plausible biological mechanisms, such as shared genetic components for ADHD and cardiovascular disease.”

The study authors acknowledged that the new research has some limitations. Due to its observational design, this study does not establish a causal role of ADHD in increasing the risk of cardiovascular disease.

The authors used national registries to identify people with ADHD and cardiovascular disease, which can only represent people with severe symptoms of ADHD or cardiovascular disease. This may have resulted in an underestimate of the number of people with less severe symptoms of ADHD or cardiovascular disease.

Conversely, people with ADHD are more likely to attend healthcare facilities and may be more likely to be diagnosed with cardiovascular disease.

The average age of the study population was around 50 years. Thus, it is likely that the study included people with early-onset cardiovascular disease diagnosed at or before the age of 60. Therefore, additional studies involving older adults are needed to examine the association between ADHD and late-onset cardiovascular disease.

In addition, data on some cardiovascular risk factors were either incomplete or missing. Dr. Lavie noted that “details on medications and doses are not known. There were also no strong data on physical activity, sedentary behavior, or physical fitness, as well as alcohol and drug use.