Key result
Sodium-containing acetaminophen is linked to ~59% higher 1-year cardiovascular disease risk in hypertension.
Why the study?
High sodium intake is linked to increased CVD and mortality risks in hypertension, but the effects among individuals without hypertension have been equivocal.
Does the initiation of sodium-containing acetaminophen increase the risk of incident cardiovascular disease and mortality compared to non-sodium-containing acetaminophen in older adults with and without hypertension?
Cohort (n=298,697)
Yes
Does the initiation of sodium-containing acetaminophen increase the risk of incident cardiovascular disease and mortality compared to non-sodium-containing acetaminophen in older adults with and without hypertension?
This study highlights that the hidden sodium load in effervescent and soluble acetaminophen preparations significantly increases the risk of cardiovascular events and mortality, underscoring a crucial iatrogenic cardiovascular risk factor.
Answers are grounded in this paper and cite their sources.
May warrant preferring non-sodium acetaminophen; hypothesis-generating association requiring randomized confirmation.
AIMS: Previous studies have found high sodium intake to be associated with increased risks of cardiovascular disease (CVD) and all-cause mortality among individuals with hypertension; findings on the effect of intake among individuals without hypertension have been equivocal. We aimed to compare the risks of incident CVD and all-cause mortality among initiators of sodium-containing acetaminophen with the risk of initiators of non-sodium-containing formulations of the same drug according to the history of hypertension. METHODS AND RESULTS: Using The Health Improvement Network, we conducted two cohort studies among individuals with and without hypertension. We examined the relation of sodium-containing acetaminophen to the risk of each outcome during 1-year follow-up using marginal structural models with an inverse probability weighting to adjust for time-varying confounders. The outcomes were incident CVD (myocardial infarction, stroke, and heart failure) and all-cause mortality. Among individuals with hypertension (mean age: 73.4 years), 122 CVDs occurred among 4532 initiators of sodium-containing acetaminophen (1-year risk: 5.6%) and 3051 among 146 866 non-sodium-containing acetaminophen initiators (1-year risk: 4.6%). The average weighted hazard ratio (HR) was 1.59 [95% confidence interval (CI) 1.32-1.92]. Among individuals without hypertension (mean age: 71.0 years), 105 CVDs occurred among 5351 initiators of sodium-containing acetaminophen (1-year risk: 4.4%) and 2079 among 141 948 non-sodium-containing acetaminophen initiators (1-year risk: 3.7%), with an average weighted HR of 1.45 (95% CI 1.18-1.79). Results of specific CVD outcomes and all-cause mortality were similar. CONCLUSION: The initiation of sodium-containing acetaminophen was associated with increased risks of CVD and all-cause mortality among individuals with or without hypertension. Our findings suggest that individuals should avoid unnecessary excessive sodium intake through sodium-containing acetaminophen use.
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Zeng et al. (2022) conducted a cohort in Older adults with and without hypertension (n=298,697). Sodium-containing acetaminophen vs. Non-sodium-containing acetaminophen was evaluated on Incident cardiovascular disease (myocardial infarction, stroke, and heart failure) at 1 year among individuals with hypertension (HR 1.59, 95% CI 1.32-1.92). Initiation of sodium-containing acetaminophen was associated with a significantly increased risk of incident cardiovascular disease compared with non-sodium formulations in both hypertensive (HR 1.59) and non-hypertensive (HR 1.45) individuals.
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