Are Amphetamines Associated with Adverse Cardiovascular Events Among Elderly Individuals?

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Table 1.

Demographic and Health Characteristics Before and After Propensity Score Matching

	Before propensity score matching			After propensity score matching
Characteristics	Amphetamine (N = 4966)	Non-Amphetamine (N = 8267)	P value	Amphetamine (N = 4966)	Non-Amphetamine (N = 4966)	P value
Age, mean ± SD	69.6 ± 4.25	70.1 ± 4.77	< .001	69.6 ± 4.25	69.67 ± 4.39	.42
Female, n (%)	3153 (63.5)	5191 (62.8)	.42	3153 (63.5)	3158 (63.6)	.69
Race/ethnicity, n (%)
White	4450 (89.6)	7351 (88.9)	.22	4450 (89.6)	4512 (90.9)	.04
Black	110 (2.2)	251 (3.0)	<.01	110 (2.2)	87 (1.8)	.10
Hispanic/Latino	70 (1.4)	159 (1.9)	.03	70 (1.4)	64 (1.3)	.60
Not Hispanic/Latino	3927 (79.1)	6366 (77.0)	<.01	3927 (79.1)	3960 (79.7)	.41
Body mass index, mean ± SD	28.19 ± 5.83	28.61 ± 6.08	<.01	28.19 ± 5.83	28.54 ± 6.11	.06
Essential hypertension, n (%)	2523 (50.8)	4191 (50.7)	.90	2523 (50.8)	2510 (50.5)	.79
Diabetes, n (%)	741 (14.9)	1294 (15.7)	.26	741 (14.9)	692 (13.9)	.16
Hyperlipidemia, n (%)	2627 (52.9)	4547 (55.0)	.02	2627 (52.9)	2590 (52.2)	.46

Table 2.

Adverse Cardiovascular Outcomes Among Individuals Older than 65 Years Who Are Exposed and Unexposed to Amphetamines

	Before propensity score matching			After propensity score matching
Outcomes	Overall Risk n/N (%)	Odds Ratio (CI)	P value	Overall Risk n/N (%)	Odds Ratio (CI)	P value
Cardiovascular Event
Amphetamine	191/4966 (3.85)	7.07 (5.12, 9.76)	<.01	191/4966 (3.85)	6.16 (4.22, 8.99)	<.01
Non-Amphetamine	45/8267 (0.54)			31/4966 (0.62)
Heart failure
Amphetamine	35/4966 (0.7)	5.83 (2.89, 11.76)	<.01	35/4966 (0.7)	3.5 (1.74, 7.06)	<.01
Non-Amphetamine	10/8267 (0.12)			10/4966 (0.2)
Stroke
Amphetamine	25/4966 (0.5)	4.16 (2.0, 8.66)	<.01	25/4966 (0.5)	2.5 (1.2, 5.2)	.01
Non-Amphetamine	10/8266 (0.12			10/4966 (0.2)
Myocardial infarction
Amphetamine	10/4966 (0.2)	1.66 (0.69, 4.0)	.25	10/4966 (0.2)	1.0 (0.42, 2.4)	1.0
Non-Amphetamine	10/8267 (0.12)			10/4966 (0.2)
Ischemic heart disease
Amphetamine	78/4966 (1.57)	8.12 (4.74, 13.88)	<.01	78/4966 (1.57)	7.09 (3.78, 13.31)	<.01
Non-Amphetamine	16/8267 (0.19)			11/4966 (0.22)
Arrhythmias
Amphetamine	69/4966 (1.39)	7.66 (4.39, 13.37)	<.01	69/4966 (1.39)	6.9 (3.56, 13.38)	<.01
Non-Amphetamine	15/8267 (0.18)			10/4966 (0.2)
Atrial fibrillation
Amphetamine	44/4966 (0.89)	7.32 (3.69, 14.54)	<.01	44/4966 (0.89)	4.4 (2.22, 8.73)	<.01
Non-Amphetamine	10/8267 (0.12)			10/4966 (0.2)

Table 3.

Biological Metrics After Propensity Score Matching

Biological Metric	Amphetamine (Mean ± SD)	Non-Amphetamine (Mean ± SD)	t Test	P value
HDL cholesterol (mg/dL)	59.38 ± 19.48	57.62 ± 18.22	2.9	<.01
LDL cholesterol (mg/dL)	105.96 ± 34.2	106.57 ± 34.52	−0.57	.57
Diastolic blood pressure (mm Hg)	75.69 ± 10.38	74.63 ± 10.54	4.13	<.01
Systolic blood pressure (mm Hg)	129.99 ± 17.24	128.54 ± 16.68	3.3	<.01
Hemoglobin A1c (%)	6.05 ± 1.08	6.02 ± 1.06	0.93	.35

HDL, high density lipoprotein cholesterol; LDL, low density lipoprotein cholesterol; SD, standard deviation.

Appendix 1:

Coding System Identifiers

Coding System	Code	Description
Adverse cardiovascular event codes
ICD-10	F90	ADHD
ICD-10	I48	Atrial fibrillation
ICD-10	I49	Arrhythmia
ICD-10	I50	Congestive heart failure
ICD-10	I20; I22-I25	Ischemic heart disease
ICD-10	I21	Myocardial infarction
ICD-10	I63	Stroke
Amphetamine-related medication codes
RxNorm	725	Amphetamine
RxNorm	3288	Dextroamphetamine
RxNorm	6816	Methamphetamine
RxNorm	6901	Methylphenidate
RxNorm	700810	Lisdexamfetamine
Comorbidity diagnosis codes
ICD-10	E08-E13	Diabetes (type I and type II)
ICD-10	I10	Essential hypertension
Diagnostic testing codes
LOINC	9000	Total cholesterol
LOINC	9001	HDL
LOINC	9002	LDL
LOINC	9037	Hemoglobin A1c
LOINC	9083	Body mass index
LOINC	9085	Systolic blood pressure
LOINC	9086	Diastolic blood pressure

ADHD, attention-deficient/hyperactivity disorder. HDL, high density lipoprotein cholesterol; ICD-10, International Classification of Diseases, Version 10; LDL, low density lipoprotein Cholesterol; LOINC, Logical Observation Identifiers Names and Codes.