Background: There is increasing concern that prescription stimulants may be associated with adverse\r\ncardiovascular events such as stroke, myocardial infarction, and sudden death. Public health concerns are amplified\r\nby increasing use of prescription stimulants among adults.\r\nMethods: The objective of this study was to conduct a systematic review of the evidence of an association\r\nbetween prescription stimulant use and adverse cardiovascular outcomes. PUBMED, MEDLINE, EMBASE and Google\r\nScholar searches were conducted using key words related to these topics (MESH): ADHD; Adults; Amphetamine;\r\nAmphetamines; Arrhythmias, Cardiac; Cardiovascular Diseases; Cardiovascular System; Central Nervous Stimulants;\r\nCerebrovascular; Cohort Studies; Caseââ?¬â??control Studies; Death; Death, Sudden, Cardiac; Dextroamphetamine; Drug\r\nToxicity; Methamphetamine; Methylphenidate; Myocardial Infarction; Stimulant; Stroke; Safety. Eligible studies were\r\npopulation-based studies of children, adolescents, or adults using prescription stimulant use as the independent\r\nvariable and a hard cardiovascular outcome as the dependent variable.\r\nResults: Ten population-based observational studies which evaluated prescription stimulant use with cardiovascular\r\noutcomes were reviewed. Six out of seven studies in children and adolescents did not show an association\r\nbetween stimulant use and adverse cardiovascular outcomes. In contrast, two out of three studies in adults found\r\nan association.\r\nConclusions: Findings of an association between prescription stimulant use and adverse cardiovascular outcomes\r\nare mixed. Studies of children and adolescents suggest that statistical power is limited in available study\r\npopulations, and the absolute risk of an event is low. More suggestive of a safety signal, studies of adults found an\r\nincreased risk for transient ischemic attack and sudden death/ventricular arrhythmia. Interpretation was limited due\r\nto differences in population, cardiovascular outcome selection/ascertainment, and methodology. Accounting for\r\nconfounding and selection biases in these studies is of particular concern. Future studies should address this and\r\nother methodological issues.
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