A new study found that acetaminophen changes proteins in the cardiovascular tissue, potentially affecting heart function.
- Acetaminophen, commonly known as Tylenol, is a widely used OTC
medication for mild to moderate pain.
- Past studies show that in people with heart disease, acetaminophen
is the preferred pain treatment over other types of pain medications like
NSAIDs.
- A new study using a mouse model discovered that acetaminophen
changes proteins in the heart tissue, potentially affecting biochemical
pathways needed for important functions.
Acetaminophen —
the active ingredient in Tylenol —
is a widely used over-the-counter (OTC) medication used for the treatment of
mild to moderate pain, as well as for fever reduction.
Past studies show that in people with heart
disease, acetaminophen is the preferred pain treatment over other types of
pain medications like aspirin and ibuprofen, which
are known as nonsteroidal anti-inflammatory drugs (NSAIDs).
A new study presented during the annual meeting of the American Physiological Society April 4–7 has
discovered — using a mouse model — that acetaminophen changes proteins in the
heart tissue.
These implications could potentially affect biochemical
pathways needed for functions like energy production and antioxidant use.
Effects
of acetaminophen on heart function
For this study, researchers used a mouse model to study the
effects of acetaminophen on heart tissue.
Some mice were given plain water, while others were
administered water containing an amount of acetaminophen equivalent to 500 mg —
the concentration found in one tablet of extra-strength Tylenol.
After seven days, researchers found significant changes in
the heart tissue proteins of the mice given acetaminophen compared to the mice
that only had water.
These protein alterations were associated with biochemical
pathways responsible for many functions, including energy production,
antioxidant usage, and the breakdown of damaged proteins.
The scientists found more than 20 different signaling
pathways affected by the protein changes.
“We were surprised by the findings since we predicted that
acetaminophen, when used at these concentrations, would have minimal effects on
the heart,” Gabriela
Del Toro Rivera, a doctoral student in the laboratory of Aldrin Gomes, PhD,
at the University of California, Davis, and the first author of this study,
told Medical News Today.
“While existing literature primarily associates acetaminophen
overuse with liver
damage, our research suggests that acetaminophen may influence tissues
beyond the liver.”
Is
acetaminophen safe for people with heart disease?
Historically, acetaminophen has been the safest pain reliever
for people with cardiovascular disease.
A study published in March 2015 found the use of
acetaminophen was not linked to a higher risk of stroke, myocardial
infarction, or any cardiovascular event.
Other recent studies have evaluated the safety of
acetaminophen in people with heart disease.
Research published
in 2022 found the use of sodium-containing acetaminophen as associated with
increased risk for cardiovascular disease and all-cause mortality in people
with or without high blood pressure.
Another 2022 study reported
that regularly taking 4 grams of acetaminophen each day increased systolic
blood pressure in people with high blood pressure, potentially increasing their
heart disease risk.
“Since acetaminophen is one of the most commonly used
over-the-counter drugs worldwide, gaining a better understanding of how
acetaminophen may affect the heart is essential for improving patient safety,
optimizing treatment decisions, managing comorbidities, and guiding future
research and development efforts,” Del Toro Rivera said.
“Findings regarding acetaminophen’s
effects on the heart have the potential to enhance doctor-patient communication
by enabling more personalized recommendations, informed decision-making, and
proactive management of potential risks associated with its use. Utilizing
acetaminophen for the shortest duration and at the lowest effective dosage
appropriate for an individual’s ailment is likely advisable.”— Gabriela Del Toro Rivera,
first study author
Effects
of acetaminophen vs. NSAIDs on heart health
While both acetaminophen and NSAIDs assist with pain relief,
NSAIDs also help lower inflammation, which acetaminophen does not do.
Past studies show that NSAID use is associated with an
increased risk for several cardiovascular concerns, including:
“Non-steroidal anti-inflammatory drugs, such as naproxen,
ibuprofen, and diclofenac,
are associated with an increased risk of stroke, and our research suggests that
these commonly used drugs alter signaling pathways and cause mitochondrial
dysfunction in mouse hearts,” Del Toro Rivera said.
“To determine if
the anti-inflammatory properties of NSAIDs were responsible for the changes
observed in mouse hearts from mice treated with NSAIDs, we investigated the
impact of acetaminophen on proteins in heart tissue,” she continued.
“Since acetaminophen is commonly used and does not contain
anti-inflammatory properties, the effects on the heart that would be observed
would not be due to anti-inflammatory results.”
Is regular acetaminophen use safe?
After reviewing this research, Cheng-Han
Chen, MD, a board certified interventional cardiologist and medical
director of the Structural Heart Program at MemorialCare Saddleback Medical
Center in Laguna Hills, CA, told MNT he was surprised by the
findings.
“We typically recommend acetaminophen as a medicine that
people can take for pain that should not have any harm to the heart,” Chen
explained.
“(With) NSAIDs, we do worry about its
effects such as increased
risk of clotting and increasing blood pressure. Typically, we
recommend (that) our heart patients take acetaminophen instead since most of
our studies show that it does not have a harmful effect on the heart. With so
many patients taking acetaminophen, It would definitely be important to know
whether it has effects that we don’t know about.”— Cheng-Han Chen, MD,
cardiologist
MNT spoke with Rigved Tadwalkar, MD, a board certified consultant
cardiologist at Providence Saint John’s Health Center in Santa Monica, CA,
about the study.
Tadwalkar said he was concerned and cautious about the implications
of the study findings.
“The findings indicate that even at moderate doses considered
safe for use, acetaminophen may have significant effects on signaling pathways
within the heart tissue,” Tadwalkar said.
“This suggests
that the commonly used painkiller might not be as benign as previously thought,
especially when used regularly over time.”
“As a cardiologist, it is
particularly troubling given that many of our patients rely on acetaminophen
for pain relief, especially considering that other pain medications often pose
significant risks,” he added. “Understanding the potential risks associated
with acetaminophen use underscores the need for increased awareness, in order
to make better decisions for patient care.— Rigved Tadwalkar, MD, cardiologist
Human studies on acetaminophen and
heart health needed
Chen said the changes in how the heart responds to
acetaminophen in mice show the heart was under more stress.
“It remains to be seen whether this also translates to
humans,” Chen said. “This mouse research should lead to human studies, probably
starting from observational studies, to investigate whether there are cardiac
outcome effects from acetaminophen.”
Tadwalkar said the next steps for this research should
involve further investigation into the mechanisms by which acetaminophen
affects the heart and cardiovascular system and whether similar findings can be
reproduced in humans.
“This should
include studies in human subjects to determine if the findings observed in mice
translate to humans,” Tadwalkar said.
“It would be valuable to explore
whether there are certain subpopulations of patients who may be more
susceptible to the cardiac effects of acetaminophen, such as those with
preexisting cardiovascular conditions or other comorbidities,” he concluded.
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