Use of methylphenidate is associated with increased risk of out-of-hospital cardiac arrest in the general population: a nationwide nested case-control study.

Abstract

Methylphenidate, a sympathomimetic drug prescribed to treat attention-deficit/hyperactivity disorder (ADHD), is associated with cardiovascular events, but few studies have explored the risk of out-of-hospital cardiac arrest (OHCA). We investigated whether methylphenidate use is associated with OHCA in the general population. Using Danish nationwide registries, we conducted a nested case-control study with OHCA-cases of presumed cardiac causes and age/sex/OHCA-date matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the odds ratio (OR) of OHCA comparing methylphenidate use with no use of methylphenidate. The study population consisted of 46578 OHCA-cases (median:72 years [IQR:62-81]), 68.8% men) and 232890 matched controls. Methylphenidate was used by 80 cases and 166 controls, and was associated with increased OR of OHCA compared to non-users (OR:1.78[95%-CI:1.32-2.40]). The OR was highest in recent starters (OR≤180 days:2.59[95%-CI:1.28-5.23]). The OR of OHCA associated with methylphenidate use did not vary significantly by age (p-value interaction:0.37), sex (p-value interaction:0.94), and pre-existing cardiovascular disease (p-value interaction:0.27). Furthermore, the ORs remained elevated when we repeated the analyses in individuals without registered hospital-based ADHD (OR:1.85[95%-CI:1.34-2.55]), without severe psychiatric disorders (OR:1.98 [95%-CI:1.46-2.67]), without depression (OR:1.93: [95%-CI:1.40-2.65]), or in non-users of QT-prolonging drugs (OR:1.79[95%-CI:1.27-2.54]). Methylphenidate use is associated with an increased risk of OHCA in the general population. This increased risk applies to both sexes and is independent from age and the presence of cardiovascular disease.