TY - JOUR

T1 - Use of methylphenidate is associated with increased risk of out-of-hospital cardiac arrest in the general population

T2 - a nationwide nested case-control study

AU - Eroglu, Talip E.

AU - Halili, Andrim

AU - Arulmurugananthavadivel, Anojhaan

AU - Coronel, Ruben

AU - Kessing, Lars Vedel

AU - Fosbøl, Emil Loldrup

AU - Folke, Fredrik

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar Hilmar

N1 - Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.

PY - 2023

Y1 - 2023

N2 - Aim Methylphenidate, a sympathomimetic drug prescribed to treat attention-deficit/hyperactivity disorder (ADHD), is associated with cardiovascular events, but few studies have explored the risk of out-of-hospital cardiac arrest (OHCA). We investigated whether methylphenidate use is associated with OHCA in the general population.Methods and results Using Danish nationwide registries, we conducted a nested case-control study with OHCA cases of presumed cardiac causes and age/sex/OHCA-date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the odds ratio (OR) of OHCA by comparing methylphenidate use with no use of methylphenidate. The study population consisted of 46 578 OHCA cases [median: 72 years (interquartile range: 62–81), 68.8% men] and 232 890 matched controls. Methylphenidate was used by 80 cases and 166 controls, and was associated with an increased OR of OHCA compared with non-users {OR: 1.78 [95% confidence interval (CI): 1.32–2.40]}. The OR was highest in recent starters (OR≤180 days: 2.59, 95% CI: 1.28–5.23). The OR of OHCA associated with methylphenidate use did not vary significantly by age (P-value interaction: 0.37), sex (P-value interaction: 0.94), and pre-existing cardiovascular disease (P-value interaction: 0.27). Furthermore, the ORs remained elevated when we repeated the analyses in individuals without registered hospital-based ADHD (OR: 1.85, 95% CI: 1.34–2.55), without severe psychiatric disorders (OR: 1.98, 95% CI: 1.46–2.67), without depression (OR: 1.93, 95% CI: 1.40–2.65), or in non-users of QT-prolonging drugs (OR: 1.79, 95% CI: 1.27–2.54).Conclusion Methylphenidate use is associated with an increased risk of OHCA in the general population. This increased risk applies to both sexes and is independent of age and the presence of cardiovascular disease.

AB - Aim Methylphenidate, a sympathomimetic drug prescribed to treat attention-deficit/hyperactivity disorder (ADHD), is associated with cardiovascular events, but few studies have explored the risk of out-of-hospital cardiac arrest (OHCA). We investigated whether methylphenidate use is associated with OHCA in the general population.Methods and results Using Danish nationwide registries, we conducted a nested case-control study with OHCA cases of presumed cardiac causes and age/sex/OHCA-date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the odds ratio (OR) of OHCA by comparing methylphenidate use with no use of methylphenidate. The study population consisted of 46 578 OHCA cases [median: 72 years (interquartile range: 62–81), 68.8% men] and 232 890 matched controls. Methylphenidate was used by 80 cases and 166 controls, and was associated with an increased OR of OHCA compared with non-users {OR: 1.78 [95% confidence interval (CI): 1.32–2.40]}. The OR was highest in recent starters (OR≤180 days: 2.59, 95% CI: 1.28–5.23). The OR of OHCA associated with methylphenidate use did not vary significantly by age (P-value interaction: 0.37), sex (P-value interaction: 0.94), and pre-existing cardiovascular disease (P-value interaction: 0.27). Furthermore, the ORs remained elevated when we repeated the analyses in individuals without registered hospital-based ADHD (OR: 1.85, 95% CI: 1.34–2.55), without severe psychiatric disorders (OR: 1.98, 95% CI: 1.46–2.67), without depression (OR: 1.93, 95% CI: 1.40–2.65), or in non-users of QT-prolonging drugs (OR: 1.79, 95% CI: 1.27–2.54).Conclusion Methylphenidate use is associated with an increased risk of OHCA in the general population. This increased risk applies to both sexes and is independent of age and the presence of cardiovascular disease.

KW - Methylphenidate

KW - Pharmacoepidemiology

KW - Sudden cardiac arrest

U2 - 10.1093/ehjcvp/pvad028

DO - 10.1093/ehjcvp/pvad028

M3 - Journal article

C2 - 37070942

AN - SCOPUS:85176495109

VL - 9

SP - 658

EP - 665

JO - European Heart Journal - Cardiovascular Pharmacotherapy

JF - European Heart Journal - Cardiovascular Pharmacotherapy

SN - 2055-6837

IS - 7

ER -