1967-2023年ADHD药物相关心血管疾病的全球负担:利用世界卫生组织药物警戒数据库进行比较分析。

IF 3.8 4区 医学 Q1 PSYCHIATRY
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引用次数: 0

摘要

背景:尽管注意力缺陷多动障碍(ADHD)药物被广泛使用,而且其对心血管系统的拟交感作用也已为人所知,但利用全面的全球数据对这些药物进行心血管风险评估却很有限。本研究利用全球药物警戒数据调查了个别ADHD药物与心血管疾病(CVD)之间的关联:方法:采用世界卫生组织国际药物警戒数据库中的报告(1967-2023 年;报告总数,n=131,255,418)。计算报告几率比(ROR)和信息成分(IC),以评估每种药物与特定心血管疾病之间的关联:结果:在所有关于ADHD药物的146,489例报告中,我们发现了13,344例心血管疾病与ADHD药物有关。自2010年以来,有关ADHD药物的累计报告呈稳步增长趋势,尤其是在成人中。总体而言,ADHD 药物与较高的心血管疾病风险相关(ROR [95 % CI],1.60 [1.58-1.63];IC [IC0.25],0.63 [0.60]),女性的相关性高于男性。在特定的心血管疾病中,所有药物都会增加心肌梗塞/QT延长、心肌病和心肌梗死的风险。相反,心力衰竭、中风和心源性死亡/休克只与苯丙胺类药物有关。与苯丙胺类药物相比,利眠宁与所有心血管疾病的相关性较弱,而哌醋甲酯与心血管疾病的总体相关性最低。阿托莫西汀与心肌梗死/QT延长的相关性位居第二:结论:心血管疾病与多动症药物之间的关联各不相同,苯丙胺类药物的风险较高,而立思辰和哌醋甲酯的安全性较好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Global burden of ADHD medication-associated cardiovascular disease, 1967–2023: A comparative analysis using the WHO pharmacovigilance database

Background

Despite the widespread use of attention-deficit hyperactivity disorder (ADHD) medications and their known sympathomimetic effects on the cardiovascular system, cardiovascular risk assessment of these medications using comprehensive global data is limited. This study investigated the association between individual ADHD medications and cardiovascular disease (CVD) using global pharmacovigilance data.

Methods

Reports from the World Health Organization international pharmacovigilance database were utilized (1967–2023; total reports, n=131,255,418). Reporting odds ratios (ROR), and information components (IC) were calculated to evaluate the association between each medication and specific CVDs.

Results

We identified 13,344 CVD cases related to ADHD medications out of 146,489 cases of all reports on ADHD medications. Cumulative reports on ADHD medications have shown a steady increase, notably in adults since 2010. ADHD medications were associated with a higher risk of CVD overall (ROR [95 % CI], 1.60 [1.58–1.63]; IC [IC0.25], 0.63 [0.60]), with a higher association observed in females than in males. Among specific CVDs, all drugs were associated with an increased risk of torsade de pointes/QT prolongation, cardiomyopathy, and myocardial infarction. Conversely, heart failure, stroke, and cardiac death/shock were exclusively associated with amphetamines. Lisdexamfetamine showed a weaker association with all CVDs compared to amphetamines, and methylphenidate exhibited the lowest overall association with CVD. Atomoxetine had the second-highest association with torsade de pointes/QT prolongation.

Conclusions

The associations between CVDs and ADHD medications vary, with amphetamines posing a higher risk, while lisdexamfetamine and methylphenidate exhibit better safety profiles.

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来源期刊
Asian journal of psychiatry
Asian journal of psychiatry Medicine-Psychiatry and Mental Health
CiteScore
12.70
自引率
5.30%
发文量
297
审稿时长
35 days
期刊介绍: The Asian Journal of Psychiatry serves as a comprehensive resource for psychiatrists, mental health clinicians, neurologists, physicians, mental health students, and policymakers. Its goal is to facilitate the exchange of research findings and clinical practices between Asia and the global community. The journal focuses on psychiatric research relevant to Asia, covering preclinical, clinical, service system, and policy development topics. It also highlights the socio-cultural diversity of the region in relation to mental health.
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