Though it is generally understood that hearing worsens with advanced age, there remains some debate as to whether the noise exposure history, dietary patterns, general health or genetic makeup of individuals contributes most to this chronic problem. For the past decade, and for the past five years especially, there has been an expansion in the number of published studies looking at modifiable risk factors that may contribute to hearing loss. For instance, there are current studies that show a compelling relationship between acquired hearing impairment and poor cardiovascular fitness and hypertension. Additionally, cardio-metabolic disorders (e.g., metabolic syndrome, Type 2 diabetes) and high risk behaviors, such as smoking, have been implicated in acquired hearing impairments. Conversely, moderate alcohol consumption has been described as a potential protective factor. So, what is the final word on the issue? Does cardiovascular disease cause hearing loss, or not? Is exercise protective of cochlear function, or is it a risk factor? Can hearing loss be an indication, or biomarker, for underlying cardiovascular disease?