BACKGROUND Psychostimulants and atomoxetine have been shown to increase blood pressure, heart rate, and QT interval in children and adolescents; however, based on current literature, it is unclear if these "attention-deficit/hyperactivity disorder (ADHD) medications" are also associated with serious cardiovascular (SCV) events. We addressed this question in commonly exposed groups of children and adolescents with either ADHD or autism spectrum disorder (ASD). METHODS Using commercial (years 2000-2016) and Medicaid (years 2012-2016) administrative claims data from the United States (US), we conducted two case-control studies, nested within respective cohorts of ADHD and ASD children aged 3-18 years. We defined cases by a composite outcome of stroke, myocardial infarction, or serious cardiac arrhythmia. For each case, we matched ten controls on age, sex, and insurance type. We conducted conditional logistic regression models to test associations between SCV outcomes and a primary exposure definition of current ADHD medication use. Additionally, we controlled for resource use, cardiovascular and psychiatric comorbidities, and use of medications in a variety of sensitivity analyses. RESULTS We identified 2,240,774 children for the ADHD cohort and 326,221 children for the ASD cohort. For ADHD, 33.9% of cases (63 of 186) versus 32.2% of controls (598 of 1860) were exposed, which yielded an odds ratio (OR) and 95% confidence interval (CI) of 1.08 (0.78-1.49). For ASD, 12.5% of cases (6 of 48) versus 22.1% of controls (106 of 480) were exposed [OR 0.49 (0.20-1.20)]. Covariate-adjusted results and results for individual outcomes and other exposure definitions were consistent with no increased risk of SCV events. CONCLUSION Using large US claims data, we found no evidence of increased SCV risk in children and adolescents with ADHD or ASD exposed to ADHD medications.

中文翻译：

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多动症或自闭症谱系障碍儿童的心理刺激剂/阿托西汀和严重心血管事件。

背景技术精神兴奋剂和阿莫西汀已被证明可增加儿童和青少年的血压，心率和QT间隔。然而，根据目前的文献，尚不清楚这些“注意力缺陷/多动障碍（ADHD）药物”是否也与严重的心血管（SCV）事件有关。我们在患有ADHD或自闭症谱系障碍（ASD）的儿童和青少年中经常接触的人群中解决了这个问题。方法使用美国（US）的商业（2000-2016年）和医疗补助（2012-2016年）行政索赔数据，我们进行了两个案例对照研究，分别嵌套在3-18岁的ADHD和ASD儿童队列中。我们根据中风，心肌梗塞或严重心律失常的复合结果来定义病例。对于每种情况，我们在年龄，性别和保险类型上匹配了十个控件。我们进行了条件逻辑回归模型以测试SCV结果与当前ADHD药物使用的主要暴露定义之间的关联。此外，我们在各种敏感性分析中控制了资源使用，心血管和精神疾病合并症以及药物的使用。结果我们确定了2,240,774名ADHD患儿和326,221名ASD患儿。对于多动症，暴露了33.9％的病例（186个中的63个），而对照组的32.2％（1860个中的598个）被暴露，其比值比（OR）和95％置信区间（CI）为1.08（0.78-1.49）。对于ASD，暴露于病例的12.5％（48个病例中的6个）与对照的22.1％（480个病例中的106个）[OR 0.49（0.20-1.20）]。经协变量调整的结果以及针对单个结果和其他暴露定义的结果与SCV事件风险没有增加相一致。结论使用大量美国索赔数据，我们没有发现暴露于ADHD药物的ADHD或ASD的儿童和青少年SCV风险增加的证据。