Background Available prediction models of cardiovascular diseases (CVDs) may not accurately predict outcomes among individuals initiating pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). Objective To improve the predictive accuracy of traditional CVD risk factors for adults initiating pharmacological treatment of ADHD, by considering novel CVD risk factors associated with ADHD (comorbid psychiatric disorders, sociodemographic factors and psychotropic medication). Methods The cohort composed of 24 186 adults residing in Sweden without previous CVDs, born between 1932 and 1990, who started pharmacological treatment of ADHD between 2008 and 2011, and were followed for up to 2 years. CVDs were identified using diagnoses according to the International Classification of Diseases, and dispended medication prescriptions from Swedish national registers. Cox proportional hazards regression was employed to derive the prediction model. Findings The developed model included eight traditional and four novel CVD risk factors. The model showed acceptable overall discrimination (C index=0.72, 95% CI 0.70 to 0.74) and calibration (Brier score=0.008). The Integrated Discrimination Improvement index showed a significant improvement after adding novel risk factors (0.003 (95% CI 0.001 to 0.007), p<0.001). Conclusions The inclusion of the novel CVD risk factors may provide a better prediction of CVDs in this population compared with traditional CVD predictors only, when the model is used with a continuous risk score. External validation studies and studies assessing clinical impact of the model are warranted. Clinical implications Individuals initiating pharmacological treatment of ADHD at higher risk of developing CVDs should be more closely monitored. Data may be obtained from a third party and are not publicly available. The Public Access to Information and Secrecy Act in Sweden prohibits individual-level data to be publicly available. Researchers who are interested in replicating this study can apply for individual level data at Statistics Sweden: www.scb.se/en/services/guidance-for-researchers-and-universities/

中文翻译：

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开始注意力缺陷/多动障碍药物治疗的成人心血管疾病风险预测模型

背景现有的心血管疾病（CVD）预测模型可能无法准确预测开始注意力缺陷/多动障碍（ADHD）药物治疗的个体的结果。目的 通过考虑与 ADHD 相关的新型 CVD 危险因素（合并精神疾病、社会人口因素和精神药物），提高对开始 ADHD 药物治疗的成人传统 CVD 危险因素的预测准确性。方法 该队列由 24 186 名居住在瑞典且既往没有 CVD 的成年人组成，出生于 1932 年至 1990 年之间，他们于 2008 年至 2011 年间开始 ADHD 药物治疗，并随访长达 2 年。心血管疾病是根据《国际疾病分类》进行诊断来识别的，并根据瑞典国家登记册开出药物处方。采用 Cox 比例风险回归来推导预测模型。研究结果 开发的模型包括八个传统的 CVD 风险因素和四个新的 CVD 风险因素。该模型显示出可接受的总体辨别力（C 指数 = 0.72，95% CI 0.70 至 0.74）和校准（Brier 得分 = 0.008）。添加新的风险因素后，综合辨别力改善指数显示出显着改善（0.003（95% CI 0.001 至 0.007），p<0.001）。结论 当模型与连续风险评分一起使用时，与仅使用传统 CVD 预测因子相比，纳入新的 CVD 风险因素可能会更好地预测该人群的 CVD。外部验证研究和评估模型临床影响的研究是必要的。临床意义 应更密切地监测患有心血管疾病的较高风险的开始 ADHD 药物治疗的个体。数据可能从第三方获得，并且不公开。瑞典的《公众获取信息和保密法》禁止公开个人数据。有兴趣重复这项研究的研究人员可以在瑞典统计局申请个人层面的数据：www.scb.se/en/services/guidance-for-researchers-and-universities/