Association of Cardiovascular Comorbidities With Hearing Loss in the Older Old

Abstract

Importance: In the United States, the population of individuals older than 80 years is expected to double in the next 40 years. Cardiovascular comorbidities are prevalent in this older old population, and their relationship with hearing loss has not been well characterized.

Objective: To investigate the association of cardiovascular disease (CVD)-related risk factors with auditory function among the older old (>80 years).

Design, setting, and participants: Audiological data and medical records from 2001 through 2014 of 433 patients aged 80 to 106 years at an academic medical center were analyzed in 2017.

Main outcomes and measures: The degree of low- and high-frequency hearing loss of participants with coronary artery disease, diabetes, hypertension, history of cerebrovascular accident, and smoking status was compared with that of disease-free individuals. Rate of hearing loss was also determined.

Results: Among the 433 patients (67% female; mean [SD] age, 89 [5.8] years), the presence of at least 1 cardiovascular morbidity was associated with elevated mean (SD) low-frequency pure-tone average (LFPTA) of 42.4 (1.6) vs 36.9 (3.5) decibels hearing loss (dB HL), a difference of 5.47 (95% CI, 4.15-9.49) dB HL. Among the 96 patients with 2 audiograms performed at age 80 years or older from which the rate of hearing loss could be calculated, 32 patients had CVD or related risk factors and 64 were healthy controls. Those with at least 1 disease had accelerated hearing loss. Patients with cardiovascular morbidity experienced a faster mean (SD) decline in LFPTA of 1.90 (0.27) vs 1.18 (0.42) dB HL/y, a difference of 0.72 (95% CI, 0.08-1.36) dB HL/y. Of the conditions studied, coronary artery disease had the highest association with audiometric thresholds and was associated with hearing loss at all frequencies tested and with poor word recognition score. Hearing loss was more strongly associated with CVD risk factors in men than in women.

Conclusions and relevance: In this study of the older old, cardiovascular risk factors and disease were associated with worse hearing and a greater rate of hearing deterioration. Hearing loss in women was less associated with the presence of CVD, possibly owing to the cardioprotective effects of estrogen. The association of hearing with CVD severity and management remains to be determined.

Figure 1.. Association of Cardiovascular Disease With Hearing Level and Rate of Decline

A, The presence of at least 1 cardiovascular morbidity was associated with elevated mean (SD) low-frequency pure-tone average (LFPTA) of 42.4 (1.6) vs 36.9 (3.5) decibels hearing loss (dB HL), a difference of 5.47 (95% CI, 4.15-9.49) dB HL. Cardiovascular disease was also associated with elevated mean (SD) high-frequency pure-tone average (HFPTA) of 62.3 (1.5) vs 60.6 (3.5) dB HL, a difference of 1.8 (95% CI, −2.0 to 5.6) dB HL. B, Patients with cardiovascular morbidity experienced faster mean (SD) decline of LFPTA of 1.90 (0.27) vs 1.18 (0.42) dB HL/y, a difference of 0.72 (95% CI, 0.08-1.36) dB HL/y. High-frequency pure-tone average declined at a mean (SD) rate of 3.71 (0.72) dB HL/y in those with cardiovascular disease vs 2.29 (0.92) dB HL/y in those without, a difference of 1.43 (95% CI, −0.32 to 3.18) dB HL/y. Error bars indicate 95% confidence interval.

Figure 2.. Association of Age and Presence of Comorbidities With Low- and High-Frequency Hearing

A, Age was correlated with low-frequency pure-tone average (LFPTA) (r = 0.33; 95% CI, 0.25-0.42). B, When the sample was stratified by presence or absence of cardiovascular disease (CVD), age was only correlated with thresholds in those with disease (r = 0.34; 95% CI, 0.25-0.43) and not in healthy individuals (r = 0.07; 95% CI, −0.18 to 0.38). C, Age was correlated with high-frequency pure-tone average (HFPTA) (r = 0.27; 95% CI, 0.18-0.36). D, When the sample was stratified by presence or absence of CVD, age was only correlated with thresholds in those with disease (r = 0.30; 95% CI, 0.21-0.39) and not in healthy individuals (r = 0.04; 95% CI, −0.20 to 0.29). dB HL indicates decibels hearing loss; dots indicate individual patients.