'Hidden' salt in paracetamol linked to increased risk of heart disease - study

Article By: Josh Luckhurst

Salt is used in some soluble paracetamol because it can encourage the process of the breakdown of the tablet in water

“Hidden” salt in some types of paracetamol has been linked to an increased risk of heart disease and death in a large new study.

Thanks to safety messages, people are more conscious than ever about the levels of salt in their food.

But they might be unaware of the levels of salt in some medicines that they take.

Salt is used in some soluble paracetamol because it can encourage the process of the breakdown of the tablet in water.

Experts have said that some people can exceed their recommended daily salt limit through a full course of salt-containing paracetamol alone.

Others called for front of pack warnings for paracetamol which contains high levels of salt.

Medics also said that people should be prescribed drug formulations with an extremely low amount of salt or none at all.

Researchers set out to compare outcomes for people who take sodium-containing soluble, or an effervescent, paracetamol and those who take the pain relief drug with no salt in it.

The team used data from 790 UK GP surgeries which collectively look after 17 million patients.

They tracked 60 to 90-year-olds between 2000 and 2017 who had either been prescribed salt containing paracetamol or non-salt-containing paracetamol – those in tablet, capsules or oral suspension forms.

The international team of researchers tracked 300,000 people, half had high blood pressure and half did not, for a year.

The study, published in the European Heart Journal, found that the risk of cardiovascular disease was higher among those who took paracetamol with salt in it.

The researchers found the risk of heart attack, stroke or heart failure after one year for patients with high blood pressure taking sodium-containing paracetamol was 5.6%, while it was 4.6% among those taking non-sodium-containing paracetamol.

Among those who did not have high blood pressure, the risk of cardiovascular disease after a year was 4.4% among those taking salt-containing paracetamol compared to 3.7% for those taking paracetamol without salt.

Risk of death during the follow-up period was also higher among those taking paracetamol with salt in it.

Lead author of the study, Professor Chao Zeng from Central South University in Changsha, China, said: “Given that the pain relief effect of non-sodium-containing paracetamol is similar to that of sodium-containing paracetamol, clinicians may prescribe non-sodium-containing paracetamol to their patients to minimise the risk of cardiovascular disease and death.

“People should pay attention not only to salt intake in their food but also not overlook hidden salt intake from the medication in their cabinet.”

He added: “Our results suggest re-visiting the safety profile of effervescent and soluble paracetamol.”

In a linked editorial, two experts from the The George Institute for Global Health, in Australia, wrote: “The direct message from this study is clear – there are likely to be millions of people worldwide taking paracetamol on a daily basis in a ‘fast-acting’ effervescent or soluble formulation who are increasing their risks of cardiovascular disease and premature death.

“In the UK alone, in 2014 there were some 42 million paracetamol containing medicines prescribed, with a further 200 million packs sold over the counter. This equates to 6,300 tonnes of paracetamol sold each year in the UK.

“Fortunately, only a small proportion of paracetamol formulations contain sodium but, with ‘fast-acting’ and ‘fizzy’ medications increasing in popularity, the adverse effects of medication related sodium intake look set to rise rather than fall.

“There are also many more effervescent, dispersible, and soluble medications and vitamin pills that contain large quantities of hidden sodium.”

They added: “There is an immediate need for protection of consumers against these risks. The most plausible and effective strategy is likely to be the mandatory labelling of all medications containing significant quantities of sodium with a front-of-pack warning label.”

The researchers estimate that 170 out of every 10,000 adults in the UK use sodium-containing medication.

Elderly people and women are more likely to use drugs with salt in them.

Commenting on the study, Professor Sir Nilesh Samani, medical director at the British Heart Foundation, said: “Eating too much salt can increase blood pressure. Cutting down on salt in our diets is an important way we can help to keep our blood pressure under control and reduce our risk of having a heart attack or stroke. However, this large analysis suggests that people who take some types of paracetamol may have inadvertently been consuming too much sodium, one of the main components of salt.

“One important limitation of this study is that we don’t know how much salt people were already consuming in their diets, as this was not captured in the data analysed. This means we don’t know whether there were any differences in salt consumption between the groups which could have affected their risk of developing a heart and circulatory condition or dying.

“It’s also important to remember that observational studies like these can only show an association, rather than prove cause and effect.

“This research looked at people who were taking effervescent and soluble paracetamol over a longer period. If you take paracetamol that contains sodium occasionally to manage an isolated headache or very short bouts of pain, these research findings should not cause unnecessary concern.”


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