Browse by author
Lookup NU author(s): Dr Dexter CanoyORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.BACKGROUND AND AIMS: Effervescent formulations of paracetamol containing sodium bicarbonate have been reported to associate with increased blood pressure and a higher risk of cardiovascular diseases and all-cause mortality. Given the major implications of these findings, the reported associations were re-examined. METHODS: Using linked electronic health records data, a cohort of 475 442 UK individuals with at least one prescription of paracetamol, aged between 60 and 90 years, was identified. Outcomes in patients taking sodium-based paracetamol were compared with those taking non-sodium-based formulations of the same. Using a deep learning approach, associations with systolic blood pressure (SBP), major cardiovascular events (myocardial infarction, heart failure, and stroke), and all-cause mortality within 1 year after baseline were investigated. RESULTS: A total of 460 980 and 14 462 patients were identified for the non-sodium-based and sodium-based paracetamol exposure groups, respectively (mean age: 74 years; 64% women). Analysis revealed no difference in SBP [mean difference -0.04 mmHg (95% confidence interval -0.51, 0.43)] and no association with major cardiovascular events [relative risk (RR) 1.03 (0.91, 1.16)]. Sodium-based paracetamol showed a positive association with all-cause mortality [RR 1.46 (1.40, 1.52)]. However, after further accounting of other sources of residual confounding, the observed association attenuated towards the null [RR 1.08 (1.01, 1.16)]. Exploratory analyses revealed dysphagia and related conditions as major sources of uncontrolled confounding by indication for this association. CONCLUSIONS: This study does not support previous suggestions of increased SBP and an elevated risk of cardiovascular events from short-term use of sodium bicarbonate paracetamol in routine clinical practice.
Author(s): Rao S, Nazarzadeh M, Canoy D, Li Y, Huang J, Mamouei M, Salimi-Khorshidi G, Schutte AE, Neal B, Smith GD, Rahimi K
Publication type: Article
Publication status: Published
Journal: European Heart Journal
Year: 2023
Volume: 44
Issue: 42
Pages: 4448-4457
Print publication date: 07/11/2023
Online publication date: 23/08/2023
Acceptance date: 09/08/2023
Date deposited: 28/11/2023
ISSN (print): 0195-668X
ISSN (electronic): 1522-9645
Publisher: Oxford University Press
URL: https://doi.org/10.1093/eurheartj/ehad535
DOI: 10.1093/eurheartj/ehad535
Data Access Statement: Regarding accessibility of Clinical Practice Research Datalink (CPRD) data, https://www.cprd.com/primary-care explains: ‘Access to data from CPRD is subject to a full licence agreement containing detailed terms and conditions of use. Patient level datasets can be extracted for researchers against specific study specifications, following protocol approval from the Independent Scientific Advisory Committee (ISAC)’. Thus, restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available. More details of the data and data sharing are found on the CPRD website (https://www.cprd.com). The Targeted-BEHRT source code can be found on the Deep Medicine research GitHub site (https://github.com/deepmedicine).
PubMed id: 37611115
Altmetrics provided by Altmetric
