Evidence on the lipid determinants of auditory outcomes remains inconsistent. Remnant cholesterol (RC), the cholesterol fraction contained in triglyceride-rich lipoproteins, captures atherogenic and inflammatory burdens beyond conventional fractions. This study assessed the associations between RC and hearing loss across frequency ranges and between RC and tinnitus in a population-representative U.S. cohort. Identifying scalable metabolic markers may help support earlier recognition and prevention efforts to reduce avoidable hearing-related disability. Participants aged 40 years and older with valid audiometric evaluations and fasting lipid profiles were identified from the 1999–2016 National Health and Nutrition Examination Survey (NHANES) dataset. RC was estimated as total cholesterol minus the sum of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) and was evaluated across predetermined concentration ranges. The outcomes included low-, speech-, and high-frequency hearing loss defined by air-conduction thresholds and self-reported tinnitus. Weighted multivariable logistic regression models were applied, sequentially adjusting for demographic, socioeconomic, lifestyle, and clinical covariates, followed by mutual adjustment for other lipid components. Subgroup and interaction analyses evaluated effect modification, including noise exposure. In fully adjusted survey-weighted logistic models, higher RC was associated with hearing loss (OR 2.43, 95% CI 1.71–3.47) and with tinnitus (OR 1.64, 95% CI 1.31–2.06); category analyses indicated a monotonic increase (P for trend < 0.001). Associations displayed a clear dose–response across RC categories and remained robust in mutually adjusted models, whereas the inverse associations for HDL-C attenuated and became nonsignificant once RC was included. Analyses by frequency range revealed the strongest associations for high-frequency hearing loss, intermediate associations for speech-frequency hearing loss, and the weakest associations for low-frequency hearing loss. Subgroup findings were broadly consistent across strata, and interaction testing indicated amplified RC–auditory associations among participants reporting noise exposure. RC was linked to adverse auditory outcomes, including hearing loss and tinnitus, with clear dose–response patterns that persisted after mutual lipid adjustment. As a routinely available lipid-derived measure, RC may support scalable risk stratification to help prioritize earlier hearing evaluation and preventive counseling; confirmation in longitudinal cohorts and trials is needed.
Yin et al. (Thu,) studied this question.