Hearing Loss and Cardiovascular Disease: Examining the Connection

Hearing loss affects an estimated 30 million individuals aged 12 years and older in the United States, and a significant portion of those aged over 65 years have disabling hearing loss.¹ Among older adults, hearing loss is highly prevalent and often affects those with chronic comorbidities such as cardiovascular disease (CVD). A growing body of research has highlighted the link between hearing loss and CVD, with an increasing focus on CVD risk factors as potentially modifiable risk factors for hearing loss.²

“The auditory system, and in particular the cochlea, is very metabolically active,” explained Paul Mick, MD, FRCSC, MPH, associate professor in the department of surgery at University of Saskatchewan and surgical director for the Neurotology and Cochlear Implant Programs with the Saskatchewan Health Authority in Canada, in an interview with Cardiology Advisor. Risk factors for CVD are associated with microvascular damage that can interfere with molecular transport across capillary walls and may cause inflammation and oxidative stress, potentially leading to cochlear damage.³

For example, “Diabetes is thought to damage the stria vascularis through nonenzymatic glycosylation, generation of reactive oxygen species, basement membrane disruption, and hair cell excitotoxicity,” according to a retrospective cohort study published in 2018 in JAMA Otolaryngology-Head & Neck Surgery.⁴

Treating underlying cardiovascular disease may prevent or slow the progression of hearing loss, and conversely, hearing loss may suggest underlying cardiovascular disease.

Recent Findings on the Connection Between CVD and Hearing Loss

In the 2018 study, the authors examined associations between cardiovascular comorbidities and hearing loss in 433 patients aged 80 years and older in the US and found that type 2 diabetes, hypertension, coronary artery disease (CAD), and a history of cerebrovascular accident were associated with accelerated hearing loss, with CAD showing the strongest association.⁴

“Treating underlying cardiovascular disease may prevent or slow the progression of hearing loss, and conversely, hearing loss may suggest underlying cardiovascular disease,” as stated in the paper.⁴

More recently, Dr Mick and colleagues conducted a population-based study of approximately 30,000 Canadian adults aged 45 years and older and found that hypertension and the Framingham cardiovascular risk score were independently associated with greater hearing loss over a 3-year follow-up period. The results were reported in 2023 in Ear and Hearing. ³

Additionally, cross-sectional analyses conducted in the study showed that smoking, obesity, diabetes, and composite measures of cardiovascular risk were independently associated with worse hearing after adjusting for age, race and ethnicity, income, and education.³

“The study was unique because it had a large sample size and was longitudinal, and hearing was measured objectively,” Dr Mick noted.

A retrospective study published in 2023 in Scientific Reports examined audiological and general health data from electronic medical records of 6,332 patients (45.5% men) seen at a large US academic medical center data to determine the connection between CVD risk factors and hearing loss. The mean patient age was 62.96 years, and 64.0% of patients had hearing loss.²

The results showed higher odds of hearing loss among current smokers and patients with diabetes compared to non-smokers and patients without diabetes, and the presence of 2 or more major CVD risk factors was associated with 92% higher odds of hearing loss compared with patients without these risk factors. In men only, hypertension was also associated with hearing loss.²

“Improved glucose control, smoking cessation, and early BP management (for males) may promote healthy hearing although such strategies would need to be borne out by longitudinal studies,” the authors concluded.²

Another recent study investigated the CVD-hearing link in 1106 African American patients aged 21 to 94 years and observed an association between diabetes and hearing loss (odds ratio [OR], 1.48; 95% CI, 1.04–2.10). However, no associations were observed between individual CVD risk factors or overall CVD risk and cochlear dysfunction.⁵

Findings from numerous other studies in recent years have demonstrated associations between CVD risk factors as well as existing CVD and hearing loss.^6-9

In a meta-analysis published in March 2024 in Otolaryngology–Head and Neck Surgery, the authors examined data from 4 cohort studies (N = 940,771) and 6 cross-sectional studies (N = 680,349) and found that stroke, CAD, and any CVD were strongly associated with hearing loss.The overall pooled ORs for each association with hearing loss were 1.26 (95% CI, 1.16-1.37; I² = 78%) for stroke; 1.36 (95% CI, 1.13-1.64; I² = 96%) for CAD; and 1.38 (95% CI, 1.07-1.77; I² = 99%) for any CVD.¹⁰

These results suggest that clinicians treating patients with hearing loss “should be cognizant of this association and view [hearing loss] in the broader context of general health and aging,” the authors wrote.¹⁰

Clinical Implications and Next Steps

While the studies on this topic do not support a causative relationship, the findings collectively highlight a consistent link between CVD and hearing loss and underscore the importance of recognizing and treating both conditions.

Co-occurring “CVD places older individuals at greater risk for impaired hearing, and those with untreated hearing loss are at higher risk of cognitive decline, falls, depression, reduced quality of life, and social disengagement, among other problems,” according to Anil K Lalwani, MD, professor of otolaryngology–head and neck surgery and chief of the division of otology, neurology, and skull base surgery at Columbia University Vagelos College of Physicians and Surgeons in New York, New York. Dr Lalwani co-authored the 2018 study described above.⁴

Dr Mick explained that screening for hearing loss can be as simple as asking questions like “Do you have trouble hearing in a noisy place?” and “Do you have to strain to understand what people say?”¹¹ In addition, he noted the availability of free apps to screen for hearing loss, including one developed by the World Health Organization.¹²

If screening results indicate possible hearing loss, patients should be referred to an audiologist or other hearing specialist for further testing and counseling regarding treatment options, he advised.

“Hearing screening programs might be trialed in populations at risk for CVD, given the findings of our study,” he suggested. “At the same time, hearing health professionals should be aware of the link between hearing loss and CVD and be able to discuss basic strategies for preventing heart disease with their patients.”

Dr Lalwani and Dr Mick agree that further research is needed to determine whether treatment of CVD risk factors can reduce the risk or progression of hearing loss. “Longer-term follow-up and analyses of different cohorts are needed to clarify the degree to which associations may differ according to demographic and health characteristics,” Dr Mick said.

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