Regular use of common painkillers is associated with hearing loss in middle aged men

Tree earA study has found that regular use of common painkillers – such aspirin, paracetamol, and ibuprofen – increases the risk of hearing loss in men aged 40-74 years.

Using aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or paracetamol twice a week or more over a 20 year period increased the risk of hearing loss by 12%, 21%, and 22%, respectively.

Nearly a quarter (22%) of American men aged 45-64 years use aspirin weekly, largely because it prevents blood clots and is thought to ward off heart attacks in healthy people.  Furthermore, 16% of American middle aged men use paracetamol weekly, whereas 13% use ibuprofen this regularly.

However, just this week the Journal of the American Medical Association published research showing that aspirin doesn’t reduce “vascular events” – such as angina or stroke – in people who don’t have any clinical cardiovascular disease.

As such, the jury is still out on the benefits versus risks of using regular doses of aspirin to avoid cardiovascular disease, and this new research on hearing loss seems to add to the “against” pile.

This study, published in the American Journal of Medicine, assessed 26,917 male healthcare professionals who were aged 40-74 years in 1986.  These men were quizzed every two years on their use of painkillers and whether they had been professionally diagnosed with hearing loss.

Men who used paracetamol at least twice a week were 22% more likely to be diagnosed with hearing loss than people who took it less, whereas regular users of NSAIDs were 21% more likely. On the other hand, the risk was only 12% higher in men who regularly used aspirin.

For NSAIDs and acetaminophen, the risk of hearing loss increased with duration of regular use. Men who used NSAIDs or paracetemol regularly for 4 or more years were 33% more likely to develop hearing loss than those who did not use these drugs as regularly.

The risk of hearing loss varied with age and was greatest in men under 60 years of age. For aspirin, regular users aged less than 50 years and those aged 50-59 years were 33% more likely to have hearing loss than were nonregular users. Interestingly, there was no association between regular aspirin use and hearing loss in men aged 60 years or older.

For NSAIDs, men aged less than 50 years were most strongly affected: regular users aged less than 50 years were 61% more likely develop hearing loss than nonregular users. Those aged 50-59 years were 32% more likely to be diagnosed with hearing loss and those aged 60 years or older were 16% more likely.

There was a similar graded change with age for paracetamol: regular users aged under 50 years were, astoundingly, 99% more likely to have hearing loss than men who used the drug less regularly, whereas those aged 50-59 years were 38% more likely and those aged 60 years and older were 16% more likely.

The authors suggest that the age differential effect might be because hearing loss itself increases with age independently of painkiller use – after the age of 60 hearing thresholds worsen by 1 decibel a year on average. “The relative contribution of regular analgesic use to hearing loss may be greater in younger individuals before the cumulative effects of age and other factors have accrued,” they say.

Curhan S et al. (2010) Analgesic Use and the Risk of Hearing Loss in Men. The American Journal of Medicine 123 (3): 231-237. DOI: 10.1016/j.amjmed.2009.08.006

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Aspirin in colorectal cancer – a new trick for an old dog

AspirinA new study published in JAMA this week has shown that in patients with colorectal cancer, taking an aspirin a day after diagnosis reduces the risk dying from the cancer or from any cause by at least 20%.  Taking aspirin before diagnosis, however, did not have any effect of prognosis.

It has been known for a few years that regular aspirin use can reduce the risk of developing colorectal cancer.  This drug isn’t a good idea as a preventive strategy though as it is associated with gastrointestinal irritation and bleeding – pretty serious side effects.  What this new study shows is that when it comes to colorectal cancer, aspirin might be just as effective and more practical as a treatment for people who already have the disease.

In this study, the authors first followed a whopping 170,000 health professionals for 20 years.  The 1279 men and women who developed colorectal cancer then completed a survey on aspirin use every two years for a further 7-10 years.

The majority of people who used aspirin reported taking the drug as an analgesic, mostly for headache or arthritis and other musculoskeletal pain.  A notable proportion, men in particular, took aspirin for cardiovascular disease prevention, which this handy little drug has also proved effective at.

Compared with participants who did not use aspirin, people who regularly used aspirin either after diagnosis only or both before and after diagnosis were 29% less likely to die from colorectal cancer and 21% less likely to die from any cause.  On the other hand, aspirin had no effect on mortality risks in people who took aspirin before cancer diagnosis only or both before and after diagnosis.

When the analysis was restricted to people who started taking aspirin after diagnosis only,  the risks of cancer-specific mortality and overall mortality were 47% and 32% lower than in those who didn’t take aspirin at all.  Conversely, there was no benefit seen specifically in the group that took aspirin before diagnosis and continued once they knew they had colorectal cancer.

The effect of aspirin in colorectal cancer was particularly strong in patients whose primary tumors overexpressed the enzyme cyclooxygenase 2 (COX-2), which crops up in about 80% of colorectal cancers, suggesting that aspirin might be an effective treatment in the majority of people with this type of cancer.  The amount of aspirin consumed also altered the effect – the mortality risk was slightly lower in people who took 6 or more tablets a week than in those who took 0.5 to five a week.

In an accompanying editorial, Alfred Neugut at Columbia University states that “aspirin may become standard adjuvant therapy in the management of colorectal cancer.” This treatment has the added advantage of being highly specific to are therefore only useful in patients with tumors that overexpress COX-2, so that “this potential future treatment comes with its own ready-made predictive biomarker.”

Chan AT, Ogino S, Fuchs CS (2009) Aspirin Use and Survival After Diagnosis of Colorectal Cancer JAMA 302 (6): 649-658 LINK

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