"The findings call for continued vigilance in the use of these medications, especially if we continue to see expanded use in older adults. We believe prescribers know about these potential risks and these results support their continued vigilance when prescribing this drug class," Dr. Mina Tadrous of the University of Toronto, in Canada, told Reuters Health by email.
Stimulants are increasingly being used in older adults for a variety of indications, the researchers note in JAMA Network Open paper.
"An association between stimulant use and increased risk of cardiovascular (CV) events has been established among children and young adults, but few studies have explored the risk of CV events among older patients, a group with increased baseline risk," they point out.
Dr. Tadrous and colleagues evaluated the association between stimulant use and risk of CV events adults among 6,457 adults aged 66 and older who started taking a stimulant and 24,853 matched adults who did not.
Stimulant use was associated with a 40% increase in CV events within in the first 30 days after initiation (hazard ratio, 1.40; 95% confidence interval, 1.1 to 1.8) but not at 180 days (HR, 1.2; 95% CI, 0.9 to 1.6) or 365 days (HR, 1.0; 95% CI, 0.6 to 1.8).
In particular, stimulant initiation was associated with increased risk of ventricular arrhythmias (HR, 3.0; 95% CI, 1.1 to 8.7) and stroke or transient ischemic attack TIA (HR, 1.6; 95% CI, 1.1 to 2.1) at 30 days, but not at 180 or 365 days.
"When we first asked this question we knew there may be short-term and long-term CV risks," Dr. Tadrous told Reuters Health.
"The short-term risks are due to triggering arrhythmias, palpitations and a quick response by the heart to increase heart rate. Long-term we were concerned with increased blood pressure and heart rate leading to more myocardial infarctions and other CV events. What we saw is a strong signal initially but no signal long-term. This might be due to the fact that those that experience increased heart rates or any dysrhythmia stop the medications early," Dr. Tadrous explained.
A limitation of the study is the use of administrative data with no access to relevant clinical variables, such as smoking history, alcohol use, or body weight. It was also not possible examine whether there was a dose-response association; for example, whether patients on a higher dose of stimulants were at an increased risk of CV events.
Despite these limitations, the findings "suggest that safety considerations should be included when stimulants are prescribed to older adults," the researchers conclude in their paper.
Funding for the study was provided by the Institute of Clinical Evaluative Sciences (ICES) in Ontario.
SOURCE: https://bit.ly/3pApWFL JAMA Network Open, online October 25, 2021.
By Megan Brooks
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