University of Dundee salt research brings new EU legislation

A STUDY by Dr Jacob George from the University’s School of Medicine into salt levels in medicines has been used by the European Medicines Agency (EMA) to recommend a change in medicine labelling across the continent.

Dr Jacob George led a team of reseachers to a salt-based medical discovery that has brought the University of Dundee international recognition. Picture: University of Dundee.

The 2013 study by Dr George and collaborators from University College London found that millions of patients were exceeding the recommended daily limits for sodium without any additional food consumption.

This was because high levels of sodium, or salt, were to be found in many commonly prescribed medicines. Salt is added to these medicines to improve their absorption into the body, but an excess of it is harmful to heart health.

Dr George and his colleagues compared the risk of cardiovascular events (non-fatal heart attack, non-fatal stroke, or vascular death) in patients taking sodium-containing effervescent, dispersible and soluble medications with those taking non-sodium versions of the same drugs between 1987 and 2010.

Their study found that patients taking the medications containing sodium had a 16 per cent increased risk of a heart attack, stroke or vascular death compared with other patients taking the non-sodium versions of the same medications.

Dr George said: “The key thing is for people to be aware of the amount of salt that could be present in the effervescent dispersible medications they may take. The amount of salt in these tablets poses a great risk to their health.

“Prescription of these sodium-containing formulations should be done with caution, and patients prescribed them should be closely monitored for the emergence of hypertension and heart problems. Taking the maximum daily dose of some medicines can significantly increase the chances of cardiovascular events so this is a matter of public health importance and we felt it was vitally important for the salt content of medicines to be labelled in the same way as foods.

“In this study, we’ve achieved everything we wanted to achieve. We want to force manufacturers to have to declare the amount of salt in their medications. Europe is going to do this and we want the Americans to do the same too.”

Dr George’s team took into account factors which would affect their results, such as body mass index, chronic illness history and the use of certain other medications. Their results found that patients with high blood pressure were seven times more likely to have been prescribed high salt medicines, with death rates 28 per cent higher in this group. These events are largely driven by an increased risk of hypertension and stroke.

Citing this study, the Pharmacovigilance Risk Assessment Committee of the EMA has recommended that the labelling of medicines should be updated to make the sodium content clearer for patients and health care professionals. Medicines which contain more than a certain level should be clearly labelled as being high in sodium.

Dr George added: “We are really proud of this research and the way that it has impacted Scottish health. We’ll be looking at other medicines in time. Despite the focus of this study on medicine, we always wanted to raise awareness around the levels of salt in the Scottish diet generally.”

At present, the Scottish Dietary Goals recommend that adults in Scotland consume no more than 6 grams of salt per day as part of an effort to improve Scotland’s national health.