Audiometric Pattern As a Predictor of Cardiovascular Status: Development of a Model for Assessment of Risk

Objectives/hypothesis: This study hypothesizes that low-frequency hearing loss is associated with underlying cardiovascular disease. The objective of this study was to use a mathematical model of hearing thresholds to predict cardiovascular status.

Study Design: Logistic regression analyses of audiometric and cardiovascular data obtained through retrospective chart review. Application of a derived mathematical formula to a distinct prospectively enrolled cohort.

Methods: Cardiovascular status was determined for a cohort of 1,168 patients seen in the audiology division. Associations between audiogram pattern and cardiovascular variables were tested with the Mantel-Haenszel statistic controlling for age and gender. Logistic regression models were developed incorporating cardiovascular risk factors and audiogram pattern. The models were applied to a separate cohort of 90 subjects recruited from cardiology and geriatric medicine clinics in whom audiograms were performed.

Results: A significant association was found between low-frequency hearing loss and cardiovascular disease and risk factors. When controlling for age, hypertension, diabetes, smoking, and hyperlipidemia, low-frequency presbycusis was significantly associated with intracranial vascular pathology such as stroke and transient ischemic attacks. Significant associations were also seen with peripheral vascular disease, coronary artery disease, and a history of myocardial infarction. A mathematical formula using audiometric pattern and medical history to predict the probability of cardiovascular diseases and events was developed and tested.

Conclusions: Audiogram pattern correlates strongly with cerebrovascular and peripheral arterial disease and may represent a screening test for those at risk. Patients with low-frequency hearing loss should be regarded as at risk for cardiovascular events, and appropriate referrals should be considered.