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Spotlight Session - Drug Utilization Research

Session: Spotlight Poster Session A

(ASPOT24) Cardiovascular Medicine Use in Adults with ADHD: A Nationwide Study in Australia

Monday, August 26, 2024
8:00 AM – 6:00 PM CEST
Location: Foyer 3

    Presenting Author(s)

  • Masako Araki, MD, MBEth, MPH

    Research Officer
    Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia., Australia

    • Co-Author(s)

  • HZ

    Helga Zoega

    Associate professor/professor
    Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia., Australia

  • MG

    Malcolm B. Gillies, PhD

    Senior Biostatistician
    UNSW Sydney
    UNSW Sydney, Australia

  • MF

    Michael Falster

    1Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia., Australia

  • DP

    David Peiris

    The George Institute for Global Health, UNSW Sydney, Sydney Australia., Australia

  • HL

    Henrik Larsson

    4School of Medical Science, Örebro University, Örebro, Sweden., Sweden

  • JC

    Juliana de Oliveira Costa

    Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia., Australia

Background: Attention-deficit/hyperactivity disorder (ADHD) may be associated with up to a two-fold increase in cardiovascular disease (CVD) incidence in adulthood. However, cardiovascular medicine use to prevent and manage CVDs among adults with ADHD is understudied.

Objectives: This cross-sectional study aimed to compare patterns of real-world cardiovascular medicine use between Australian adults with and without ADHD, by estimating the prevalence of cardiovascular medicine use in both groups and quantifying the difference through prevalence ratios (PRs), overall and by sex, age and medicine type.

Methods: Using a nationally representative dispensings sample from the Pharmaceutical Benefits Scheme, we identified 14,753 adults with ADHD, defined as ≥2 dispensings of ADHD medicines from 2012-2020 (18-29 [41.5%], 30-49 [43.0%], 50-64 [12.5%], ≥65 [3.0%] years). We randomly selected 59,012 age- and sex-matched adults without ADHD. We estimated the prevalence of cardiovascular medicine use (2021) among adults with and without ADHD by sex and age group and by medicine type. To examine the association of ADHD with cardiovascular medicine use, we calculated PRs with 95% confidence intervals (CIs) adjusting for age and sex, using Poisson regression. We conducted a post hoc analysis excluding propranolol, due to common off-label use.

Results: Compared with those without ADHD, adults with ADHD had higher use of cardiovascular medicines, with an elevated prevalence for antithrombotic agents (2.2% vs 1.4%), nonselective beta-blocker (propranolol) (3.2% vs 0.7%), loop diuretics (0.8% vs 0.4%) and potassium-sparing diuretics (0.9% vs 0.4%). Overall cardiovascular medicine use was also more prevalent (16.5% vs 10.0%, PR: 1.7, 95%CI: 1.6-1.7), with the highest difference among adults aged 18-29 (6.0% vs 2.2%, PR: 2.8, 95%CI: 2.4-3.1). Stratified by sex, we observed an elevated prevalence of propranolol, furosemide, and spironolactone among females with ADHD, compared with females without ADHD but not among males, suggesting potential effect modification by sex. In the post hoc analysis, PRs decreased slightly, but patterns of use remained consistent across age and sex, with the highest relative difference still among adults aged 18-29 (3.6% vs 1.6%, PR: 2.2, 95%CI: 1.9-2.6).

Conclusions: The association between ADHD and cardiovascular medicines was strongest in young adults, indicating a high relative burden of CVD in this group. We identified that the elevated use of cardiovascular medicine among young adults with ADHD was partly driven by propranolol. Our findings support that clinicians should ensure regular cardiovascular assessment for people with ADHD and underscore young adulthood as a critical period for cardiovascular screening.