Dataset Information

Assessment of Stimulant Use and Cardiovascular Event Risks Among Older Adults

ABSTRACT: This cohort study investigates the association of prescription stimulant use with risk of cardiovascular events among adults aged 66 years and older. Key Points

Question

Is prescription stimulant use associated with an increased risk of cardiovascular (CV) events among adults aged 66 years and older?

Findings

In this cohort study of 6457 older adults who initiated stimulant use and 24 853 matched older adults who did not initiate such use, stimulant use was associated with a 40% increase in CV events within 30 days of initiation. Risk attenuated over time, with no association with increased risk at 180 days or 365 days after initiation.

Meaning

These findings suggest that safety considerations should be included when stimulants are prescribed to older adults.

Importance

Use of stimulants continues to increase among older adults for a variety of indications. An association between stimulant use and increased risk of cardiovascular (CV) events has been established among children and young adults, but few studies have explored the risk of CV events among older patients, a group with increased baseline risk.

Objective

To evaluate the association between stimulant use and risk of CV events among older adults.

Design, Setting, and Participants

This propensity score–matched cohort study, with 4 nonusers per 1 user, was conducted from July 1, 2017, to June 27, 2019, using data from population-based health care databases from Ontario, Canada, from January 1, 2002, to December 31, 2016. Included individuals were outpatients aged 66 years or older.

Exposures

Initiation of a prescription stimulant.

Main Outcomes and Measures

The primary outcome was a CV event, defined as a composite of emergency department visit or hospitalization for myocardial infarction, stroke or transient ischemic attack (TIA), or ventricular arrhythmia. Risk of CV event was assessed at 30 days, 180 days, and 365 days after initiation of stimulants from Cox proportional hazard models. A secondary analysis assessed each component of the primary outcome separately.

Results

Among 6457 older adults who initiated a prescription stimulant (ie, the exposed group) and 24 853 older adults who did not initiate such treatment (ie, the unexposed group), the distribution of baseline patient characteristics was well balanced after matching (sex: 3173 [49.1%] men vs 12 112 [48.7%] men; standardized difference, 0.01; median [IQR] age: 74 [69-80] years vs 74 [69-80] years; standardized difference, 0.01). Within this cohort, there were 932 CV events during the 365-day follow-up (5.11 events per 100 person-years among individuals who initiated stimulants). In the primary analysis, stimulant initiation was associated with increased risk of CV events at 30 days (hazard ratio [HR], 1.4; 95% CI, 1.1-1.8) but not at 180 days (HR, 1.2; 95% CI, 0.9-1.6) or 365 days (HR, 1.0; 95% CI, 0.6 to 1.8). In the secondary analysis, stimulant initiation was associated with increased risk of ventricular arrhythmias (HR, 3.0; 95% CI, 1.1-8.7) and stroke or TIA (HR, 1.6; 95% CI, 1.1-2.1) at 30 days.

Conclusions and Relevance

This cohort study found that stimulant use was associated with an early increase in CV events among older adults with no association for long-term use.

SUBMITTER: Tadrous M

PROVIDER: S-EPMC8546494 | biostudies-literature |

REPOSITORIES: biostudies-literature

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