Pre-existing cardiovascular conditions and pharmacological treatment of adult ADHD.

Abstract

BACKGROUND:

Stimulants and atomoxetine should generally not be used or used only with caution in adults with pre-existing cardiovascular conditions. The extent to which pre-existing cardiovascular conditions influence initiation of these ADHD medications in adults is not known.

METHODS:

We performed a retrospective cohort study of privately insured adults with new ADHD treatment episodes. Pre-existing cardiovascular conditions were assessed by the presence of ICD-9-CM codes for congenital abnormalities, atherosclerosis, cardiac disease, and cerebrovascular disease in the 12 months before the index ADHD diagnosis. The primary outcome was new initiation of a stimulant or atomoxetine in the 3 months after the index date. Multivariate logistic regression was used to predict the likelihood of treatment initiation with stimulants or atomoxetine based on pre-existing cardiovascular conditions, patient demographic characteristics, clinical mental disorder comorbidities, other psychotropic drug use, and provider type.

RESULTS:

Of 8752 patients with a new ADHD treatment episode, 917 (10.5%) had evidence of >or=1 pre-existing cardiovascular condition. Stimulants were started by 40.8% of patients with and 53.0% of patients without pre-existing cardiovascular conditions (Adjusted Odds Ratio, AOR 0.71; 95%CI 0.61-0.82). Pre-existing cardiovascular conditions reduced the likelihood of initiating stimulant treatment in younger but not in older patients (p-value for age x cardiovascular condition interaction = 0.0002). Initiation of atomoxetine treatment was not affected by pre-existing cardiovascular conditions (AOR 1.19, 95%CI 0.94-1.50).

CONCLUSIONS:

Pre-existing cardiovascular conditions reduce the likelihood of stimulant therapy but not atomoxetine treatment in adult ADHD patients. However, many adult ADHD patients with pre-existing cardiovascular conditions initiate stimulant therapy.

• Authors: Tobias Gerhard, Almut G Winterstein, Mark Olfson, Cecilia Huang, Arwa Saidi, Stephen Crystal
• Journal: Pharmacoepidemiology and drug safety (Pharmacoepidemiol Drug Saf) Vol. 19 Issue 5 Pg. 457-64 (May 2010) ISSN: 1099-1557 [Electronic] England
• PMID: 20232490 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)
• Copyright: (c) 2010 John Wiley & Sons, Ltd.

Chemical References

• Central Nervous System Stimulants
• Propylamines
• Atomoxetine Hydrochloride

Topics

• Adult
• Atomoxetine Hydrochloride
• Attention Deficit Disorder with Hyperactivity (complications, drug therapy)
• Cardiovascular Diseases (chemically induced, complications, diagnosis)
• Central Nervous System Stimulants (administration & dosage, adverse effects, therapeutic use)
• Cohort Studies
• Drug Utilization
• Female
• Humans
• Insurance Claim Review
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Propylamines (administration & dosage, adverse effects, therapeutic use)
• Retrospective Studies
• Young Adult