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Is coenzyme Q10 effective in decreasing myalgias in patients receiving statin therapy?

analysis of four studies included only adults: a total of 967,591 stimulant users and matched controls. Adults with ADHD were treated with methylphenidate, methamphetamine, amphetamine salts, or atomoxetine. Medication dosing regimens were not specified. Primary outcomes were sudden death or arrhythmia, and secondary outcomes were stroke, myocardial infarction, and all-cause death. Follow-up ranged from 60 days to 10 years, with a median of 5 years. In the pooled analysis of the four adult studies, no significant association was noted between ADHD medications and sudden death/ arrhythmia compared with nonusers of stimulants (relative risk [RR] 1.2; 95% CI, 0.77–2.0; I574) or stroke (RR 1.1; 95% CI, 0.75–1.6). No pooled analysis of the other secondary outcomes was found. Only one study (n543,955) of adults exclusively included new users of methylphenidate with unspecified duration of use. Compared with nonusers, new patients treated with methylphenidate had an increased chance for sudden death/ventricular arrhythmia (hazard ratio [HR] 1.8; 95% CI, 1.3–2.6) and all-cause mortality (HR 1.8; 95% CI, 1.6–1.9). No statistically significant difference was observed in HRs for stroke or myocardial infarction. Aside from this one study, all other studies agreed with the overall findings of the meta-analysis. Limitations included study heterogeneity and large variations in follow-up duration. A 2013 meta-analysis of 10 randomized controlled trials (n52,665) examined changes in blood pressure and pulse in adults on stimulant medications for ADHD treatment. Study participants had a median age of 36 years old and treatment duration ranged from 4 to 24 weeks with median treatment duration of 6 weeks. In seven trials, patients were treated with methylphenidate 30 to 82 mg (n51, 936), the remaining three trials used amphetamines 40 to 50 mg (n5729). Nine of the trials used the long-acting form ofmedication (n52,380), with one study using both long-acting and immediate release form of medication (n5285). In the pooled analysis of all 10 studies, patients treated with stimulants demonstrated an increase in resting heart rate by 5.7 bpm compared with placebo (95% CI, 3.6–7.8 bpm). Additionally, systolic blood pressure increased an average of 2.0 mmHg (95% CI, 0.8–3.2 mmHg). Overall studies reported no serious cardiovascular events (myocardial infarction, atrial fibrillation, sudden cardiac death, or heart failure) or drug discontinuation because of cardiovascular symptoms compared with those on placebo. Limitations included evaluation of disease-oriented outcomes, short study duration, and younger population (making results less generalizable to older populations at increased risk of cardiovascular disease).