Carvedelol and Hearing Loss

I found one small study that showed an association that was statistically significant. (note there’s a difference between being signficant and statistically significant) Personally I wouldn’t worry about it. However if you’re concerned, you could ask your doctor if there’s another beta blocker that you could replace it with. If you’ve got congestive heart failure, carvedilol is really the preferred drug. Again, I personally wouldn’t concern myself with it as 1) it was a small study 2) It’s only one study. Stuff like this is found all the time and usually amounts to nothing.

I don’t have congestive heart failure; just two stents in my LAD…

MDB: I found one small study that showed an association that was statistically significant. (note there’s a difference between being significant and statistically significant) Personally I wouldn’t worry about it. However if you’re concerned, you could ask your doctor if there’s another beta blocker that you could replace it with. If you’ve got congestive heart failure, carvedilol is really the preferred drug. Again, I personally wouldn’t concern myself with it as 1) it was a small study 2) It’s only one study. Stuff like this is found all the time and usually amounts to nothing.

Even the abstract is confusing, because it says early on that “Carvedilol was significantly associated with hearing loss. Other beta-blockers including metoprolol and atenolol showed no association with hearing loss.” That wording (“significantly associated”) is research-speak to mean that there was a statistical association that is unlikely a random relationship. BUT… as MDB is suggesting… the relationship may be relatively minor, meaning that there may be only a small increase in the risk or degree of hearing loss related to use of this medication.

I’ve seen screaming headlines for medical studies in mainstream media for something that increases risk by 3%. Well… you know… if you need the drug for congestive heart failure, with a small increase in risk for hearing problems, which could mean either a minor increased risk of hearing loss, or an increased risk of minor hearing loss, maybe that’s a risk you take. To even understand what the risk actually is, you have to see what they actually found and how they got there. This abstract doesn’t say, and we can’t see more about the study without, probably, an expensive payment to the journal.

So farther down in the one-paragraph study abstract, it phrases the issue differently. It says there: “Chronic use of carvedilol was associated with significant hearing loss.” That has a completely different meaning in research-speak, because it’s suggesting that the risk of significant hearing loss is not minor. But it’s very sloppy writing and editing to have this contradiction in the same abstract, which would make many doctors want to take a closer look at the research methodology to see if a strong warning about hearing loss is justified. And it’s sloppy, sloppy, sloppy to not specify the level of loss observed even in the abstract. I’m suspicious of this study.

Generally speaking, clinicians are cautioned not to use abstracts only to make medical practice decisions, because a more careful reading of the study may clarify that there is reduced cause for concern.

Neville: Was it causal or just correlated? Because I could certainly see congestive heart failure being the causal factor for both Carvedelol and hearing loss."

It was a correlational study, which as Neville understands, means it has less importance than a causal study. They ran a lot of data, and this was the one conclusion they came up with. Approached that way, there is some degree of chance that another study would not find the same result, because if researchers run enough statistical correlations, they will find one that sticks to meet the test of “statistical significance,” but it may indeed be a random and not a real, or really important, variation. Researchers are under a lot of academic career pressure to find something when they do a study. Sometimes there’s noise about nothing of real concern that comes out of research that doesn’t hold up when others test the relationship.

Talk about it with your cardiologist. If the cardio doc feels that there may be cause for concern about hearing loss that outweighs the risk of changing beta blockers to metoprolol or atenolol, then you may want to make the change. But the smarter choice may be to stay with the drug you have, because it may give you the best chance for good overall health going forward.