Associations Between Cardiovascular Risk Factors and Audiometric Hearing: Findings From the Canadian Longitudinal Study on Aging

Abstract

Objectives: The objectives of the study were to determine, among a population-based sample of Canadian adults, if risk factors for cardiovascular disease (alone and in combination) were associated with hearing loss. Cross-sectional and longitudinal associations (the latter with about 3 years of follow-up) were examined. Risk factors considered included diabetes, dyslipidemia, hypertension, obesity, and smoking. We also aimed to determine if associations were modified by sex and age group (45 to 54, 55 to 64, 65 to 74, and 75 to 86 years old at baseline). Design: A secondary analysis of data collected for the Canadian Longitudinal Study on Aging was performed. Data were collected in two waves, the first between 2012 and 2015, and the second between 2015 and 2018. Hearing was measured using screening air-conduction pure-tone audiometry. The outcome of interest was defined as the mid-frequency (1000, 2000, 3000, and 4000 Hz) pure-tone average for both ears. Diabetes was defined based on self-reported physician diagnosis, use of diabetes medications, or a hemoglobin A1c level ≥6.5%. Dyslipidemia was determined by blood lipid profile as defined using the Canadian guidelines for the diagnosis and treatment of dyslipidemia (low-density lipoprotein cholesterol ≥3.5 mmol/L or non-high-density lipoprotein cholesterol ≥4.3 mmol/L). Hypertension was determined by self-reported physician diagnosis or an average systolic blood pressure ≥140 mm Hg or an average diastolic blood pressure ≥90 mm Hg. Obesity was defined as a waist-to-height ratio ≥0.6. Smoking history was determined by self-report (current/former/never-smoker). Two composite measures of cardiovascular risk were also constructed: a count of the number of risk factors and a general cardiovascular risk profile (Framingham) score. Independent associations between risk factors for cardiovascular disease and hearing were determined using multivariable regression models. Survey weights were incorporated into the analyses. All results were disaggregated by sex. Effect modification according to age was determined using multiplicative interaction terms between the age group and each of the risk factor variables. A complete case (listwise deletion) approach was performed for the primary analysis. We then repeated the multivariable regression analyses using multiple imputation using chained equations to determine if the different approaches to dealing with missing data qualitatively changed the outcomes. Results: In longitudinal analyses, hypertension and the general cardiovascular risk profile score were associated with greater loss of hearing over the 3-year follow-up period for both sexes. In addition, smoking in males and obesity in females were associated with faster rates of hearing decline. In cross-sectional analyses, smoking, obesity, diabetes, and composite measures were each independently associated with worse hearing for both sexes (although for females, obesity was only associated with hearing loss in the 55 to 64-year-old age group). The results were similar for the complete case and multiple imputation approaches, but more cross-sectional associations were observed using multiple imputation. Conclusions: Diabetes, obesity, hypertension, and smoking were associated with hearing loss. Higher combinations of risk factors increased the risk of hearing loss. Further studies are needed to confirm age and sex differences and whether interventions to address these risk factors could slow the progression of hearing loss in older adults.

The Hearing Function and Ambulatory Blood Pressure in Older Adults

“…We found no association between PTA and 24-hour or daytime BP. This is consistent with a cross-sectional study by Umesawa et al 7 who found no association between hypertension (based on clinic BP measurement) and moderate to severe hearing loss among Japanese workers, and with Mick et al 15 who did not find a cross-sectional association between hypertension (again clinic BP) and PTA at frequencies from 1000 to 4000 Hz in middle-aged and older Canadian adults. Lastly, another study with data from the Korea National Health and Nutrition Examination Surveys did not observe an association between hearing loss and hypertension in participants with normal otoscopy.…”

“…7,8 On the one hand, it has been observed that increased systolic BP (SBP), diastolic BP (DBP), and hypertension were associated with hearing loss and impairment of auditory processing. [9][10][11][12][13] On the contrary, other studies did not observe associations between hypertension and hearing loss, 7,8,14,15 nor with cochlear deterioration. 16 Some age-associated conditions, including disability, 17,18 frailty, 19,20 and dementia, 21,22 have been associated with both hearing loss and hypertension, suggesting that they may have shared mechanisms.…”

Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health

“…In an analysis of data from the Canadian Longitudinal Study on Aging (CLSA), an interaction between age and obesity among women was noted, whereby the association was present among women aged 55 to 64 years, but not in other age groups. In this same study, cross-sectional associations between composite measures of cardiovascular risk and hearing loss were also strongest among 55 to 64 year old women (Mick et al 2021b). Using data from the Health ABC study, Helzner et al (2005) reported that the risk of hearing loss associated with smoking was stronger in Black women (OR = 2.9) versus other sex/race groups, and that the risk associated with hypertension was stronger in White men (OR = 1.3) versus other sex/race groups.…”

Prevalence and risk factors of self-reported hearing and balance dysfunction in a population-based sample from rural northeastern Germany

“…Smoking was the only single factor that was significantly associated with all three audiovestibular symptoms. While in the past an association with smoking has been reported mostly individually for hearing loss (Cruickshanks et al 1998;Lin et al 2013;Tsimpida et al 2019;Engdahl, Stigum, & Aarhus 2021;Tseng et al 2022;Mick et al 2023), tinnitus Biswas & Hall 2021;Goderie et al 2022) and dizziness (Neuhauser et al 2005;Agrawal et al 2009), the underlying cause has not been clarified so far. In an animal model of oxidative stress, degeneration and loss of cochlear spiral ganglion neurons have been documented after chronic exposure to cigarette smoke (Paquette et al 2018).…”

“…CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) (Tsimpida et al 2019;Biswas & Hall 2021) and obesity (Curhan et al 2013;Hu et al 2020;Biswas & Hall 2021;Mick et al 2023) might be contributing both to hearing loss (Curhan et al 2013;Tsimpida et al 2019;Hu et al 2020;Mick et al 2023) and tinnitus Biswas & Hall 2021). It is remarkable that only smoking seems to be a shared risk factor of all three audiovestibular symptoms hearing loss (Cruickshanks et al 1998;Zhan et al 2011;Lin et al 2013;Tsimpida et al 2019;Engdahl, Stigum, & Aarhus 2021;Tseng et al 2022;Mick et al 2023), tinnitus Biswas & Hall 2021;Goderie et al 2022) and dizziness (Neuhauser et al 2005;Agrawal et al 2009) and might therefore be of particular importance.…”