Attention-deficit/hyperactivity disorder is associated with increased risk of cardiovascular diseases: A systematic review and meta-analysis

Lin Li; Honghui Yao; Le Zhang; Miguel Garcia-Argibay; Ebba Du Rietz; Isabell Brikell; Marco Solmi; Samuele Cortese; J Antoni Ramos-Quiroga; Marta Ribasés; Zheng Chang; Henrik Larsson

doi:10.1002/jcv2.12158

Attention-deficit/hyperactivity disorder is associated with increased risk of cardiovascular diseases: A systematic review and meta-analysis

JCPP Adv. 2023 Apr 5;3(3):e12158. doi: 10.1002/jcv2.12158. eCollection 2023 Sep.

Authors

Lin Li^{1

2}, Honghui Yao², Le Zhang², Miguel Garcia-Argibay¹, Ebba Du Rietz², Isabell Brikell^{2

3}, Marco Solmi^{4

5

6

7

8}, Samuele Cortese^{8

9

10

11}, J Antoni Ramos-Quiroga^{12

13

14

15}, Marta Ribasés^{13

14

15

16}, Zheng Chang², Henrik Larsson^{1

2}

Affiliations

¹ School of Medical Sciences Örebro University Örebro Sweden.
² Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden.
³ Department of Biomedicine Aarhus University Aarhus Denmark.
⁴ Department of Psychiatry University of Ottawa Ottawa Ontario Canada.
⁵ Department of Mental Health The Ottawa Hospital Ottawa Ontario Canada.
⁶ Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ottawa Ontario Canada.
⁷ Department of Child and Adolescent Psychiatry Charité Universitätsmedizin Berlin Germany.
⁸ Centre for Innovation in Mental Health-Developmental Lab School of Psychology University of Southampton Southampton UK.
⁹ Solent NHS Trust Southampton UK.
¹⁰ Hassenfeld Children's Hospital at NYU Langone New York University Child Study Center New York Hampshire USA.
¹¹ Division of Psychiatry and Applied Psychology School of Medicine University of Nottingham Nottingham UK.
¹² Department of Psychiatry and Forensic Medicine Universitat Autònoma de Barcelona Barcelona Spain.
¹³ Biomedical Network Research Centre on Mental Health (CIBERSAM) Madrid Spain.
¹⁴ Department of Mental Health Hospital Universitari Vall d'Hebron Barcelona Spain.
¹⁵ Psychiatric Genetics Unit Group of Psychiatry Mental Health and Addiction Vall d'Hebron Research Institute (VHIR) Universitat Autònoma de Barcelona Barcelona Spain.
¹⁶ Department of Genetics, Microbiology, and Statistics Faculty of Biology Universitat de Barcelona Barcelona Spain.

Abstract

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with other psychiatric and physical diseases. However, available evidence on associations between ADHD and cardiovascular diseases (CVDs) is mixed. To systematically review, quantitatively synthesize, and appraise available evidence on the link between ADHD with CVDs, we searched relevant articles in PubMed, Embase, PsycINFO, and Web of Science from inception to May 1, 2022. Study quality was assessed by using the Newcastle-Ottawa Scale, and random-effects model meta-analyses were performed. A total of 18,391,169 (ADHD: n = 421,224) individuals from 11 studies were included in our systematic review and 8,196,648 (ADHD = 332,619) individuals from five studies were included in the main meta-analysis of adjusted estimates. Pooled estimates showed that ADHD was significantly associated with an increased risk of CVDs in analyses based on adjusted effect size (odds ratio (OR) = 1.96; 95% confidence interval (CI) = 1.19-2.23, Q = 140.74, P _Q < 0.001, I ² = 97.2%). When restricted among adults, the heterogeneity declined to null (OR = 1.73; 95% CI = 1.14-2.62, Q = 6.28, P _Q = 0.10, I ² = 6.28%), suggesting age might be the main source of heterogeneity. In subgroup analyses, we found increased risk of CVDs associated with ADHD across age groups, type of CVDs, and data sources. This systematic review and meta-analyses indicate that ADHD is associated with increased risk for CVDs, but further studies with various study designs are warranted to advance the understanding of the underlying mechanisms for the observed association between ADHD and CVDs. Additional research is also needed to resolve the role of ADHD medications which remains unclear due to the limited number of primary studies exploring this issue.

Keywords: attention‐deficit/hyperactivity disorder; cardiovascular diseases; meta‐analysis; observational studies; systematic review.