ADHD in adults linked to higher risk of cardiovascular diseases

• A large population-based study in Sweden recently showed that individuals with attention deficit hyperactivity disorder (ADHD) were at a two-fold higher risk of all types of cardiovascular diseases than those without ADHD.
• Among adults with ADHD, men, younger people, and those with comorbid psychiatric conditions exhibited increased cardiovascular risk.
• The study underscores the importance of monitoring individuals 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. Still, there is limited evidence to suggest a similar association between attention deficit hyperactivity disorder (ADHD) and cardiovascular risk.

A recent nationwide study published in World Psychiatry shows that individuals with ADHD were at an increased risk of cardiovascular disease compared to those without ADHD, even after accounting for cardiovascular risk factors.

Dr. Carl Lavie, a cardiologist at the University of Queensland School of Medicine in Australia, not involved in the study, told Medical News Today:

“The study is huge with long follow-up and even considering potential errors in maintaining such a huge data bank, the study certainly suggests that ADHD is associated with possibly doubling the risk of CVD. Considering that this condition [ADHD} 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 and cardiovascular disease

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

Individuals 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 conditions, such as autism, anxiety disorders, and depression, are associated with an increased risk of cardiovascular disease. However, there is limited data suggesting an association between ADHD and an increased risk of cardiovascular disease.

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

Furthermore, the extent to which cardiovascular risk factors in individuals with ADHD influence the risk of cardiovascular diseases 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 conditions, individuals with ADHD simultaneously receive medications for other mental health conditions.

Previous studies suggest that medications used for ADHD and other mental health conditions such as anxiety and depression could increase the risk of cardiovascular disease. Thus, using these medications or the presence of mental health conditions could potentially elevate the risk of cardiovascular diseases in individuals with ADHD.

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

ADHD and cardiovascular risk

In the present study, the researchers used data on over 5.4 million Swedish adults born between 1941 and 1983 without a previous cardiovascular disease diagnosis.

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

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

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

The researchers found that cardiovascular risk factors such as heavy smoking, obesity, diabetes, sleep problems, lower educational attainment, and psychiatric conditions were more prevalent in individuals with ADHD. Yet controlling for these cardiovascular risk factors only slightly weakened the association between ADHD and the risk of cardiovascular diseases.

Moreover, excluding individuals with ADHD who were using medications 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 cardiovascular risk factors such as obesity, smoking, and comorbid psychiatric conditions, 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 diseases. The strongest association was observed between ADHD and cardiac arrest, hemorrhagic stroke, and arteriosclerosis.

Subgroups at elevated risk

The severity of core ADHD symptoms tends to decrease with age, whereas the risk of cardiovascular disease increases with aging. Moreover, ADHD and cardiovascular diseases are more prevalent in males than females.

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

In a separate analysis, the researchers found that individuals with ADHD and co-occurring psychiatric conditions, such as eating disorders and substance use disorders, were also at increased risk of cardiovascular disease than individuals with only ADHD.

The study’s findings suggest that clinicians should monitor the cardiovascular health of individuals with ADHD early to facilitate the implementation of strategies to reduce cardiovascular risk. Among individuals with ADHD, younger adults, males with ADHD, and those with comorbid psychiatric conditions could be especially at a higher risk of cardiovascular disease.

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

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

Limitations

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

The authors used national registries to identify individuals with ADHD and cardiovascular disease, which may only account for individuals with severe symptoms of ADHD or cardiovascular disease. This may have resulted in underestimating the number of individuals with less severe symptoms of ADHD or cardiovascular disease.

Conversely, individuals with ADHD are more likely to frequent 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 accounted for individuals with early onset cardiovascular disease, diagnosed at or before the age of 60 years. As a result, there is a need for additional studies involving older adults to examine the association between ADHD and late-onset cardiovascular disease.

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

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