Soluble paracetamol that contains salt is linked with a significantly increased risk of heart attacks, stroke, heart failure and death, according to a new Chinese study.
The study of nearly 300,000 patients registered with UK GPs 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% (122 cases of cardiovascular disease), while it was 4.6% (3051 of cardiovascular disease cases) among those taking non-sodium-containing paracetamol.
The risk of death was also higher: the one-year risk was 7.6% (404 deaths) and 6.1% (5,510 deaths), respectively.
There was a similar increased risk among patients without high blood pressure.
The study, published today in the *European Heart Journal*, was led by Professor Chao Zeng from Xiangya Hospital, Central South University, Changsha.
He and his team analysed data from the UK’s Health Improvement Network and looked at 4,532 patients, all aged 60-90, with high blood pressure who had been prescribed sodium-containing paracetamol.
These were compared with 146,866 patients with high blood pressure who had been prescribed paracetamol without sodium.
They also compared 5,351 patients without high blood pressure who were prescribed sodium-containing paracetamol with 141,948 patients without high blood pressure prescribed non-sodium-containing paracetamol.
Prof Zeng said the team also found the risk of cardiovascular disease and death increased the longer an individual took sodium-containing paracetamol.
“The risk of cardiovascular disease increased by a quarter for patients with high blood pressure who had one prescription of sodium-containing paracetamol, and it increased by nearly a half for patients who had five or more prescriptions of sodium-containing paracetamol,” he said.
“We saw similar increases in people without high blood pressure. The risk of death also increased with increasing doses of sodium-containing paracetamol in both patients with and without high blood pressure.”
Prof Zeng said that clinicians and patients should be aware of the risks associated with paracetamol that contains sodium and avoid unnecessary consumption, especially when the medication is taken for a long period of time.
“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,” he said.
“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.”
Zeng C, Rosenberg L, Li X et al. Sodium-containing acetaminophen and cardiovascular outcomes in individuals with and without hypertension. *European Heart Journal* 24 February 2022; doi:10.1093/eurheartj/ehac059
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