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Older adults are at high risk for heart attack, stroke and arrhythmia in the first 30 days after starting a new prescription for stimulants, according to a new study.

Use of stimulants in this population has increased in recent years, including off-label use for treating depression, post-stroke recovery, motor function and fatigue, the investigators said. The drugs are associated with increased resting heart rate and systolic blood pressure, but there has been little research into risks they might pose to elders, they added.

To examine potential risks, the researchers analyzed health data from more than 6,400 adults aged 66 and older who initiated stimulant use to determine whether there was any link between stimulants and poor cardiovascular outcomes. 

When compared with their peers who had not started taking the drugs, study participants with new prescriptions had a 40% increased risk of adverse events at 30 days. This includes ventricular arrhythmias, stroke or transient ischemic attack. The odds decreased over time, however, reported Tara Gomes, Ph.D., of the University of Toronto. By 180 days, this risk had disappeared, and there was still no greater risk at 365 days, she and her colleagues wrote.

“The evidence gap with prescription stimulant use is even more concerning given the rapid increase in stimulant uptake for a variety of indications,” they wrote. In Ontario, for example, stimulant use among older adults grew by 35% from 2013 to 2017. This tracks with trends observed in the United States, they noted.

One study in Ontario found that the most common stimulants prescribed were methylphenidate products, lisdexamfetamine, mixed-salt amphetamine, and dextroamphetamine. The drugs’ long-acting versions accounted for 90% of all prescriptions.

“Our findings do not suggest that clinicians should decrease vigilance in prescribing these agents, but rather suggest that current prescribing practices in patient selection should be continued,” researchers concluded.

The study was published in JAMA Network Open.