Clinical question: Does the use of sodium-containing acetaminophen increase the risk of cardiovascular disease (CVD) and all-cause mortality in patients with and without a history of hypertension when compared to non-sodium-containing acetaminophen?
Background: There is a common misconception that excess sodium intake comes primarily from dietary sources. The excipients of common over-the-counter medications such as some formulations of acetaminophen may contain significant amounts of sodium. For example, a 500-mg dose of soluble acetaminophen contains 390 mg of sodium, and a 500-mg dose of effervescent acetaminophen has 440 mg of sodium.
Study design: A large population-based study of two cohorts of individuals 60–90 years old.
Setting: The Health Improvement Network (THIN), a UK-based electronic medical record database was analyzed from January 2000 to December 2017. The THIN database identified individuals receiving sodium-containing and non–sodium-containing acetaminophen both with and without a diagnosis of hypertension.
Synopsis: A total of 151,398 individuals with hypertension and 147,299 individuals without hypertension were analyzed. The primary outcomes were incident CVD (myocardial infarction, stroke, and heart failure) and all-cause mortality during a one-year follow-up.
Incident CVD risk at one year was higher among sodium-containing acetaminophen initiators compared to non–sodium-containing acetaminophen initiators in individuals with a history of hypertension (5.6% versus 4.6%; hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.32–1.92) or without (4.4% versus 3.7%; HR, 1.45; 95% CI, 1.18–1.79). In addition, all-cause mortality at one year was higher in sodium-containing acetaminophen initiators compared to non–sodium-containing acetaminophen initiators with a history of hypertension (HR, 2.05; 95% CI, 1.92–2.19) or without (HR, 1.87; 95% CI, 1.74–2).
Limitations included a lack of dietary sodium intake data and no assessment of the association between sodium-containing acetaminophen and cause-specific mortality.
Bottom line: Increased risk of cardiovascular disease and all-cause mortality were associated with intake of sodium-containing acetaminophen compared to non-sodium-containing acetaminophen in individuals with and without hypertension.
Citation: Zeng C, et al. Sodium-containing acetaminophen and cardiovascular outcomes in individuals with and without hypertension. Eur Heart J. 2022;7;43(18):1743-1755. doi:10.1093/eurheartj/ehac059.
Dr. Hoque is an assistant professor of internal medicine and acting internship co-director at Saint Louis University School of Medicine, St. Louis, Mo. She is president of SHM’s St. Louis Chapter.