In particular, multiple classes of cardiovascular medications, including antihypertensives, diuretics, beta-blockers, calcium channel blockers, agents acting on the renin-angiotensin system, and lipid-lowering drugs, were strongly associated with hearing impairment, consistent with evidence that cardiovascular risk factors, such as hypertension, dyslipidemia, systemic arteriosclerosis, and diabetes, contribute to cochlear dysfunction via microcirculatory changes, oxidative stress, and chronic inflammation [50,51,52]. This evidence concerns the gene REN and metabolic syndrome.