Adults With ADHD at Higher Risk for Cardiovascular Disease, Study Shows


woman having her heart checked during doctor visit

woman having her heart checked during doctor visit


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Fast Facts

  • People with ADHD may have a higher risk for cardiovascular disease.
  • The correlational study, though large in size, does not prove a causal link between ADHD and cardiovascular disease.
  • Experts say people with ADHD should be made aware of the additional risks of cardiovascular disease.

People with attention-deficit/hyperactivity disorder (ADHD) may have a higher risk for cardiovascular disease, a new study has found. 

Conducted by researchers from Karolinska Institutet and Örebro University in Sweden, the study investigated the associations between ADHD and a wide range of cardiovascular diseases in adults. The results showed that of the individuals who were followed as part of the study, 38% of those with ADHD developed cardiovascular disease, compared with 24% of those without ADHD.

“Risks were elevated among adults with ADHD for all types of cardiovascular diseases, and especially high for cardiac arrest, hemorrhagic stroke, and peripheral vascular diseases,” lead study author Lin Li, PhD, a postdoctoral researcher in the department of medical epidemiology and biostatistics at the Karolinska Institutet, told Health.

While doctors and scientists had previously understood that there was a correlation between mental disorders and cardiovascular diseases, the newly released study is one of the few that exists on the link between ADHD and cardiovascular diseases.

Here’s a closer look at the ramifications of the findings for those who have ADHD.

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The Connection Between ADHD and Cardiovascular Disease

Prior to the new study, there was growing evidence suggesting a higher risk for cardiovascular diseases among individuals impacted by mental disorders. However, very little was known about the risk for specific types of cardiovascular diseases in people with ADHD.

In an attempt to find out more, researchers from Karolinska Institutet and Örebro University collected data from more than 5 million adults, born between 1941 and 1983. Just over 37,000 of those adults had a diagnosis of ADHD.

After a nearly 12-year follow-up, researchers found that 38% of individuals with ADHD had at least one diagnosis of cardiovascular disease, compared to 24% of people without ADHD. The findings, according to researchers, show that "ADHD was significantly associated with increased risk of any cardiovascular disease."

The strongest associations were found for cardiac arrest, hemorrhagic stroke, and peripheral vascular disease/arteriosclerosis, the researchers found. In addition, stronger associations were found in males and younger adults who had ADHD. 

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Only Association Confirmed, Not Cause

While the study was an important one because of its size and the fact that it was able to confirm a higher risk of cardiovascular disease among those with ADHD, it was not able to prove that ADHD was the cause of such health issues. Instead the study merely confirmed that there is an association between ADHD and cardiovascular risk.

“The study was large; it contained a large number of patients over a long period of time,” Dennis Finkielstein, MD, director of cardiovascular cardiology in the department of cardiovascular medicine at Lenox Hill Hospital, told Health. “You want big data when you’re looking for observations, and this one had that, but beyond that it was really just associations: The patients had both cardiovascular events and ADHD.”

According to Dr. Finkielstein, the study noted that these cardiovascular events appear to be more frequent in those who have ADHD, which means they have an increased likelihood—but more research is needed on the subject.

"It's thought provoking and research inspiring," said Dr. Finkielstein, "but what you'd need to do is a long-term trial where you take a group with the disease and one that doesn't determine."

Dr. Finkielstein added that it has been known for some time that there are associations between cardiovascular illnesses and mental disorders.

"The real question is: Is the illness itself in some way causing the physical condition, or are there co-founding factors? For example, if you have a psychiatric illness you are less likely to do things like go to the doctor, eat well, and exercise" said Dr. Finkielstein. 

The research looked at other risk factors for cardiovascular disease, including type 2 diabetes, obesity, smoking, sleep problem, and mental disorders. 

"But these do not fully explain the observed association," said Lin. "However, we don't have detailed information on lifestyles, like dietary intake and physical activities. More research is needed to explore the potential role of these factors.”

Another factor to take into consideration is the treatment of ADHD and its link to cardiovascular issues. Two of the most common ingredients in medication for ADHD are methylphenidate, which is the active ingredient in Ritalin and Concerta; and amphetamine, which is the active ingredient in Adderall and Vyvanse. Both of these are stimulants, and according to research, stimulants are often associated with the increased short-term risk of cardiovascular events.

"We don't know if it is the stimulant medication that is leading to the cardiovascular illness, or if patients with ADHD are ignoring healthy behaviors," added Dr. Finkielstein.

Because stimulant medication for ADHD is so common, Dr. Finkielstein suggested the next phase of research should focus on whether there's a dose effect to medication, which would involve studying “a group on medication versus a group off the medication.”

Lin noted that in future studies, researchers do indeed aim to explore the role ADHD medication and non-pharmacological treatment could have in reducing cardiovascular risks.

"We also need more research to explore plausible biological mechanisms, such as genetic components for ADHD and cardiovascular disease," added Lin.

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Proactive Steps to Take if You Have ADHD

There is still more work to be done when it comes to investigating the links between ADHD and increased cardiovascular risks, researchers said. But for now, one of the main takeaways from the current study is that those with ADHD should speak with their doctor or their cardiologist.

"The takeaway is, do you have other signs and symptoms or risks? If so, ADHD should be the second straw that breaks the camel's back—where you go see a cardiologist," said Dr. Finkielstein.

In addition, clinicians need to carefully consider psychiatric comorbidity and lifestyle factors to help reduce the risk of cardiovascular disease in individuals with ADHD, according to Lin.

"People with ADHD may also be aware of the potential risk of CVDs,” Lin said.

With or without ADHD, cardiovascular disease is one of the largest health issues facing Americans. Heart disease is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC). So regardless of whether or not a person has ADHD, it is a health issue to be on top of.

"In the general population when you talk about risk factors, the ones that pop up are family history, smoking and tobacco use, diabetes, and cholesterol. And, of course, there are a host of others," said Finkielstein.

The first step for anyone would be to visit their primary care doctor, and from there, if necessary, move on to a cardiologist. 

Lifestyle is also a major component in preventing and treating cardiovascular disease, which includes mental health, healthy eating, reducing stress, getting adequate sleep, and engaging in regular exercise.