Attention au sel contenu dans les médicaments

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Un comprimé effervescent de paracétamol apporte 1g de sel, soit autant qu'une poignée de chips. Pour les consommateurs quotidiens, le risque d’hypertension est multiplié par 7.

L'effervescence contribue à la rapidité d'action des comprimés. Mais cette dissolution accélérée libérant de petites bulles gazeuses se fait au prix d’une très forte teneur en sel, source de risque cardiovasculaire, alertent des chercheurs anglais dans le British Medical Journal.

Une équipe des universités de Londres et Dundee a étudié les dossiers médicaux de plus d’1,2 million de patients en séparant ceux qui avaient pris quotidiennement pendant 13 ans des médicaments effervescents, dispersibles ou solubles et ceux qui avaient consommé les formes comprimés classiques. Résultats : pour les adeptes des comprimés effervescents, le risque d’hypertension était multiplié par 7, celui d’accident vasculaire cérébral augmenté de 22% et in fine, le risque de décès était accru de 28% par rapport au groupe de patients traités avec des comprimés standards.

Hypertendus, attention au sel caché dans les médicaments effervescents

Les médicaments effervescents trop salés pour le cœur

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Etude originale :

Association between cardiovascular events and sodium-containing effervescent, dispersible, and soluble drugs: nested case-control study
British Medical Journal Published 26 November 2013
Jacob George, senior lecturer/honorary consultant in clinical pharmacology, Waseem Majeed, core medical trainee in medicine, Isla S Mackenzie, senior lecturer/honorary consultant in clinical pharmacology, Thomas M MacDonald, professor of clinical pharmacology, Li Wei, senior lecturer in medical statistics

Abstract

Objective To determine whether patients taking formulations of drugs that contain sodium have a higher incidence of cardiovascular events compared with patients on non-sodium formulations of the same drugs.

Design Nested case-control study.

Setting UK Primary Care Patients registered on the Clinical Practice Research Datalink (CPRD).

Participants All patients aged 18 or over who were prescribed at least two prescriptions of sodium-containing formulations or matched standard formulations of the same drug between January 1987 and December 2010.

Main outcome measures Composite primary outcome of incident non-fatal myocardial infarction, incident non-fatal stroke, or vascular death. We performed 1:1 incidence density sampling matched controls using the UK Clinical Practice Research Datalink (CPRD). For the secondary analyses, cases were patients with the individual components of the primary study composite endpoint of hypertension, incident heart failure, and all cause mortality.

Results 1 292 337 patients were included in the study cohort. Mean follow-up time was 7.23 years. A total of 61 072 patients with an incident cardiovascular event were matched with controls. For the primary endpoint of incident non-fatal myocardial infarction, incident non-fatal stroke, or vascular death the adjusted odds ratio for exposure to sodium-containing drugs was 1.16 (95% confidence interval 1.12 to 1.21). The adjusted odds ratios for the secondary endpoints were 1.22 (1.16 to 1.29) for incident non-fatal stroke, 1.28 (1.23 to 1.33) for all cause mortality, 7.18 (6.74 to 7.65) for hypertension, 0.98 (0.93 to 1.04) for heart failure, 0.94 (0.88 to 1.00) for incident non-fatal myocardial infarction, and 0.70 (0.31 to 1.59) for vascular death. The median time from date of first prescription (that is, date of entry into cohort) to first event was 3.92 years.

Conclusions Exposure to sodium-containing formulations of effervescent, dispersible, and soluble medicines was associated with significantly increased odds of adverse cardiovascular events compared with standard formulations of those same drugs. Sodium-containing formulations should be prescribed with caution only if the perceived benefits outweigh these risks.

Etude complète