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George A. Gates, MD; Janet L. Cobb, MPH; Ralph B. D'Agostino, PhD; Philip A. Wolf, MD

Arch Otolaryngol Head Neck Surg. 1993;119(2):156-161.

Abstract
• Hearing loss with age (presbycusis) is a substantial problem for the elderly. To investigate the possible relation of presbycusis to cardiovascular disease (CVD), the hearing status of a cohort of 1662 elderly men and women was determined and compared with their 30-year prevalence of cardiovascular disease. Age-adjusted multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) to describe the relation of hearing to cardiovascular disease events, cardiovascular disease risk factors, and both events and risk factors separately for the 676 men and for the 996 women. Cardiovascular disease events were the sum of coronary heart disease, stroke, and intermittent claudication. Five groups of risk factors were studied: hypertension and blood pressure; diabetes, glucose intolerance, and blood glucose level; smoking status and number of pack-years of cigarettes; relative weight; and serum lipid levels, including cholesterol, triglycerides, and lipoprotein fractions. Low-frequency hearing (low pure-tone average, 0.25 to 1.0 kHz) was related to cardiovascular disease events in both genders but more in the women. For women, the OR of having any cardiovascular disease event for a low pure-tone average of 40 dB hearing level was 3.06 (95% CI, 1.84 to 5.10); for a high pure-tone average (average of 4 to 8 kHz) of 40-dB hearing level, the OR for any cardiovascular disease event was 1.75 (95% CI, 1.28 to 2.40). In men with a low pure tone

average of 40-dB hearing level, the OR for stroke was 3.46 (95% CI, 1.60 to 7.45) and for coronary heart disease the OR was 1.68 (95% CI, 1.10 to 2.57). In the women, a low pure-tone average of 40 dB hearing level was associated with an OR for coronary heart disease of 2.14 (95% CI, 1.21 to 3.79) and for intermittent claudication the OR was 4.39 (95% CI, 2.02 to 9.55). Adding cardiovascular disease risk factors to the logistic regression analyses did not affect the relationships. Of the suprathreshold tests, the synthetic sentence identification test showed a relation to heart attack or strokes in women. Of the risk factors, hypertension and systolic blood pressure were related to hearing thresholds in both men and women, and blood glucose level was related to low pure-tone average in the women. High-density lipoprotein levels were inversely related to low-frequency hearing thresholds only in the women. There is a small but statistically significant association of cardiovascular disease and hearing status in the elderly that is greater for women than men and more in the low than the high frequencies. Low-frequency presbycusis is classically associated with microvascular disease leading to atrophy of the stria vascularis. Further studies of the relation of vascular disease and hearing loss in the elderly are warranted to clarify the pathophysiologic mechanisms.

(Arch Otolaryngol Head Neck Surg. 1993;119:156-161)

Author Affiliations
From the Department of Otolaryngology—Head & Neck Surgery, Washington University School of Medicine, St Louis, Mo (Dr Gates), and Departments of Mathematics (Drs Cobb and D'Agostino) and Neurology (Dr Wolf), Boston (Mass) University.

Footnotes
Accepted for publication July 10, 1992.

Reprint requests to Department of Otolaryngology—Head & Neck Surgery, Washington University School of Medicine, Campus Box 8115, 517 S Euclid, St Louis, MO 63110 (Dr Gates).

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