From Individual CKM Components to Integrated Cardiovascular-Kidney-Metabolic Staging: Audiometric Hearing Thresholds in Older U.S. Adults
Year: 2026
Type: preprint
Abstract: Cardiovascular-kidney-metabolic (CKM) syndrome integrates metabolic abnormalities, kidney dysfunction, and cardiovascular disease within a staged framework representing overall multisystem disease burden. Individual CKM components, including adiposity, blood pressure, glycemic status, lipid abnormalities, kidney function, and cardiovascular disease, have also been associated with hearing impairment. However, it remains unclear how objectively measured audiometric hearing thresholds differ across CKM stages, how individual CKM components are associated with hearing thresholds, and whether associations between continuous CKM component measures and hearing thresholds differ across CKM stages. This secondary cross-sectional study will examine these questions among U.S. civilian noninstitutionalized adults aged 70–79 years using the nationally representative NHANES 2017–March 2020 pre-pandemic dataset. CKM stage will be derived from available anthropometric, blood pressure, glycemic, lipid, kidney, medication, and cardiovascular disease data using the contemporary AHA/ACC/ADA/ASN CKM framework. Where specific clinical criteria cannot be reproduced directly from available NHANES variables, dataset-specific operational definitions will be applied and documented transparently. The first objective is to estimate adjusted differences in audiometric hearing thresholds across CKM stages. The second objective is to estimate associations between individual CKM components and hearing thresholds, using continuous measurements where appropriate and clinically relevant categories where required. The third objective is to determine whether associations between continuous CKM component measures and hearing thresholds differ across CKM stages by evaluating CKM stage × component interactions. Audiometric hearing threshold will be analyzed as a continuous outcome in decibels hearing level (dB HL), with the mean bilateral four-frequency pure-tone average (PTA4), calculated from ear-specific thresholds at 0.5, 1, 2, and 4 kHz, used as the primary audiometric measure. Analyses will adjust for age, sex, race/ethnicity, socioeconomic characteristics, cigarette smoking, and occupational and non-occupational noise exposure and will account for the NHANES complex sampling design. Because CKM status, its components, and hearing thresholds are measured contemporaneously, all findings will be interpreted as cross-sectional associations rather than causal effects or longitudinal changes in hearing.
Author: Dinh Minh Le
Language: English
Subfield: Cognitive Neuroscience
Field: Neuroscience
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W7204452940