A large, long-term study using data from the UK Biobank has found hearing loss heightens the risk of developing heart failure, with the psychological distress caused by hearing impairment playing a significant role in this association. The study, published in Heart, used information from more than 164,000 participants and is one of the first to objectively measure hearing ability and its potential impact on heart failure risk.
The study focused on participants who had no history of heart failure to begin with. The study’s goal was to explore whether hearing loss could be an indicator of heart failure risk, considering how psychological factors such as distress, social isolation, and neuroticism might impact this relationship.
The participants’ hearing ability was measured using the Digit Triplets Test (DTT) and the speech-reception threshold (SRT). The 160,062 people who didn’t wear hearing aids at the start were categorized according to performance on the DDT. Those with normal hearing comprised 88% (140,839); insufficient 10.5% (16,759); and poor were only 1.5% (2,464). Additional data including current health, lifestyle, and psychological factors was compiled via answers to questionnaires.
Social isolation factors, based on the number of people living in the household were included, as was the level of psychological stress the participants were under as measured on the Patient Health Questionnaire (PHQ-4), with scores ranging from 0 to 12. Neuroticism, a depression-related personality trait, was assessed using 12 questions from the Eysenck Personality Questionnaire-Revised Short Form.
Analysis of these data revealed that participants with poor hearing, insufficient hearing, or those who wore hearing aids had a significantly higher risk of developing heart failure compared to those with normal hearing. Specifically, participants with poor hearing showed a 28% increased risk of heart failure, while those using hearing aids had a 26% heightened risk.
The development of heart failure among those who were not genetically predisposed to the condition was identified through medical records and death certificates during an average follow-up of 11.5 years.
“This study provides new insights into the relationship between hearing impairment and heart failure, showing that poor hearing is significantly linked to an increased risk of heart failure,” the researchers wrote.
As anticipated by the researchers, higher levels of psychological distress were closely associated with the risk of heart failure in participants with poorer hearing accounting for 16.9% of the increased risk of heart failure. Other psychological factors, such as social isolation and neuroticism, were also found to contribute to the heightened heart failure risk, although to a lesser extent.
The researchers noted that, as an observational study, this research does not prove causality. Further, hearing data were collected only at the start of the study and the records of those in the study were mainly of European descent and healthier than the general population of the U.K.
That noted, the investigators did propose a potential explanation for this connection: “The rich distribution of capillaries in the…cochlea and the high metabolic demand of the inner ear may render these regions more sensitive to systemic vascular disorders rather than just local circulatory issues,” the researchers wrote. “Therefore, hearing impairment may reflect vascular health and serve as an early and sensitive predictor of cardiovascular disease, including heart failure.”
The psychological factors studied, the researchers suggested, could increase risk due to enhanced inflammation and oxidative stress, which are known to play a role in increased cardiovascular risk.
“These psychological factors may increase the activity of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, and enhance inflammation and oxidative stress, thereby accelerating atherosclerosis, increasing peripheral stress, and promoting the development of cardiac remodeling,” the researchers wrote.
The implications of these findings for healthcare are significant. The study highlights the importance of considering hearing health as part of broader cardiovascular risk assessments. Researchers suggest that addressing hearing impairment and the associated psychological distress could be an important strategy for reducing heart failure risk. “Strengthening psychological intervention in people with hearing impairment may be key to curbing the risk of heart failure,” they concluded.
The study also noted that while hearing aids improved auditory function, they did not mitigate the underlying vascular issues that may contribute to heart failure risk. This points to the need for more holistic approaches to managing hearing loss, which might include psychological support and addressing vascular health alongside auditory treatments.
