To The Editor:
Arecent article in your journal appropriately looks to examine the risk of adverse cardiovascular events in patients treated with stimulant medications (Søren et al.). However, the conclusions drawn from the findings may be erroneous, and require further clarification. The authors studied a large population-based cohort and looked for cardiovascular events in this population. Their findings would indicate that cardiovascular events are more common, approximately twofold, in children treated with these medications. If true, this alarming finding is of great importance and may lead to changes in the treatment of attention-deficit/hyperactivity disorder (ADHD). However, before any change in practice is made, clarification is needed. The majority of the cardiovascular events fall into broad categories (23% arrhythmia, 14% heart disease not otherwise specified [NOS], 40% cardiovascular disease NOS) requiring further definition. For example, “arrhythmia” may indicate sinus tachy- or bradycardia, sinus arrhythmia, or other benign diagnoses, which would not indicate alteration in treatment. Anything “not otherwise specified” raises similar concern, as this may run the gamut from palpitations without arrhythmia to noncardiac chest pain to hypo- or hypertension. The authors speculate on the physiologic etiology of their findings, but without fully defining these findings.
That these authors' findings are significant is true, not in small part because they would be the first to document adverse cardiac affects in child and/or adolescent populations. Prior studies have failed to show similar events (Westover and Halm) or an increase in mortality (Mazza et al.). I concur with questions raised regarding the population-based clinical significance, given the low incidence even in this population. However, more importantly, I also question the individual clinical significance that hinges on these lacking definitions.
Disclosures
No competing financial interests exist.
