Are Amphetamines Associated with Adverse Cardiovascular Events Among Elderly Individuals?

Trends in characteristics of the recipients of new prescription stimulants between years 2010 and 2020 in the United States: An observational cohort study

“…The trend that there has been an increase in new prescription stimulants to older individuals over the past 10 years is notable given recent evidence that prescriptions in geriatric populations is associated with more than a six-fold increased risk of cardiovascular events. 21 It is well established that stimulants increase heart rate and blood pressure among all age demographics. 26 , 27 However, the clinical relevance of this has been questioned.…”

“…Given that prescriptions to adults have outpaced those to pediatric populations, and multiple studies demonstrate increased risk of cardiovascular events in older adults, 21 , 51 the public health consequences of this fundamental shift in prescribing trends remains unclear. However, the impact may not be experienced evenly among demographic groups.…”

“…Animal models have demonstrated potentially adverse epigenetic changes related to repeated substance exposure, including FDA-approved stimulant medications such as stimulants, 18 , 19 and concern for cardiovascular risks among older adults has been raised. 20 , 21 This is relevant given prescriptions for stimulants increased by 250% in the United States from 2006-2016 while diagnoses for ADHD have increased by just 4%. 22 , 23 As such, it remains unclear who might be the primary recipient of these new stimulant prescriptions.…”

Treatment with stimulants and the risk of COVID-19 complications in adults with ADHD

“…Yet, stimulant medications can rouse the central nervous system in the prefrontal cortex, blocking the reuptake of norepinephrine and dopamine into the presynaptic neuron and increasing their release into the extraneuronal space ( Weisler et al, 2005 , Hammerness et al, 2009 ). A rise in circulating catecholamines activates cardiovascular beta-1 adrenoreceptors causing elevated inotropy and heart rates, while activation of alpha-adrenoreceptors can lead to vasoconstriction, elevated blood pressure, and cardiovascular complications, ( Latronica et al, 2021 ) which are known risk factors for worse COVID-19 severity ( Geng et al, 2021 ). ADHD has also been associated with several chronic medical and mental health conditions that often acerbate COVID-19 complications ( Nigg, 2013 ).…”

“…Adults on sustained stimulant medication have reduced ADHD symptoms leading to long-term improvements in quality of life ( Adler et al, 2008 , Chang et al, 2017 ). Side effects, through their activation of the adrenergic receptor agonists, including accelerated heart rate, blood vessel constriction, and increased blood pressure ( Latronica et al, 2021 , Olfson et al, 2013 ), have raised concerns about cardiovascular risk complications.…”