Abstract
BACKGROUND AND AIMS: Tinnitus, characterized by the conscious perception of sound without external acoustic stimulation, presents a multifaceted challenge. Recent research suggests a potential association between tinnitus and cardiovascular health. To elucidate these associations further, we examined the prevalence of tinnitus alongside its distress levels and their associations with cardiovascular risk factors, diseases, and risk of death within a general population cohort. METHODS AND RESULTS: This study analyzed data from the prospective Gutenberg Health Study (GHS), a population-based cohort of 15,010 individuals aged 35-74, who underwent baseline assessments from 2007 to 2012. We focused on the 10-year follow-up (2017-2020) of the GHS, including otologic testing with 8539 subjects, of whom 2387 (28%) reported tinnitus, allowing for a comprehensive cross-sectional and prospective analysis. Participants completed a questionnaire on hearing-related symptoms, including tinnitus presence ("Do you suffer from ringing in the ears (tinnitus)?" yes/no) and distress ("How much do you feel bothered by it?"), rated on a six-point scale from 0 ("not bothersome") to 5 ("very bothersome"). Outcomes were assessed based on observed prevalent cardiovascular conditions (i.e., cardiovascular risk factors and diseases) and deaths. Additionally, calculated cardiovascular risk was assessed using the SCORE2 algorithm. Significant differences in baseline characteristics emerged between participants with and without tinnitus, with the former exhibiting advanced age, male predominance, and a higher prevalence of cardiovascular risk factors and diseases. Tinnitus displayed associations with various prevalent cardiovascular diseases including atrial fibrillation (odds ratio 1.48, 95% confidence interval 1.11-1.96), peripheral artery disease (1.43, 1.05-1.95), coronary artery disease (1.49, 1.09-2.04), and any cardiovascular disease (1.31, 1.11-1.56), persisting even after adjustments for demographic, socioeconomic, and cardiovascular risk factors. While crude associations with several prevalent cardiovascular risk factors were observed, these associations diminished upon comprehensive adjustment. Tinnitus presence was associated with elevated 10-year cardiovascular disease risk (incidence rate ratio 1.11, 1.09-1.13), as indicated by higher SCORE 2 values, yet did not predict all-cause mortality risk. CONCLUSIONS: In the present study, tinnitus was associated with prevalent cardiovascular disease. However, no association with cardiovascular risk factors and mortality was found.