Stimulant Use in Older Adults May Increase Cardiovascular Risk

Prescription drug use has increased significantly among older adults (≥ 65 years old) from 84% to 90%.¹ Stimulant use in older adults increased 1.3-fold (95% CI: 0.5-2.2) from 1999-2000 to 2011-2012. A recent publication studied whether this increase in stimulants resulted in an increase in cardiovascular event risk in older adults.

The study compared 6457 adults aged 66 years or older who initiated a prescription for a stimulant (ie, amphetamine, methylphenidate, lisdexamfetamine, or dextroamphetamine) vs the control group of 24,853 older adults (matched for sex, gender, and age) for 30, 180, and 365 days.²

There were 5.11 cardiovascular events (composite of emergency department visit or hospitalization for myocardial infarction, stroke or transient ischemic attack, or ventricular arrhythmia/100 person-years). Stimulants were associated with an increased risk of cardiovascular events at 30 days (hazard ratio 1.4 [95% CI: 1.1-1.8]), but not at 180 days or 365 days. Stimulant use was also associated with an increase in risk of ventricular arrhythmias and stroke or transient ischemic attack.

This study provides evidence for needed pharmacovigilance in older adults who are being prescribed stimulants. A consult between the pharmacist and the prescribing physician needs to occur before the first prescription is dispensed.

References:

1. Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA. 2015;314(17):1818-31. doi:10.1001/jama.2015.13766
2. Tadrous M, Shakeri A, Chu C, et al. Assessment of stimulant use and cardiovascular event risks among older adults. JAMA Netw Open. 2021;4(10):e2130795. doi:10.1001/jamanetworkopen.2021.30795