Insulin-like Growth Factor 1 (IGF-1) is associated with cardiovascular disease, itself a risk factor for hearing impairment, and, in animal studiesafter adjustment for a range of potential confounders. Among people ≥60 y (n = 2990) there was a nonsignificant 'J'-shaped association. Our observational evidence that higher levels of IGF-1 appeared to confer some protection against hearing impairment in some older adults warrants replication in other prospective cohort studies.Age-related hearing loss (presbycusis) is the most common cause of adult auditory deficiency and it is a major cause of disability 1, 2 . For example, in the United States 3 and in the United Kingdom 4 , around two-thirds of people older than 70 years report hearing loss. As well as being an important disease entity in its own right, it has marked economic, social, and health ramifications. Thus, poor hearing has a deleterious impact on physical functioning 5 , cognitive functioning 6 , social and family life 7 and mental health 8 . In the US, aggregate societal costs, including not only medical and assistive device costs but also reduced work productivity, were estimated to be $4.6 billion over the lifetime of affected people 9 . With the condition essentially incurable, the focus becomes identification of potentially modifiable risk factors.Evidence from a range of scientific disciplines implicates Insulin-like Growth Factor 1 (IGF-1) in the aetiology of hearing loss. First, atherosclerosis 10, 11 and selected cardiovascular disease risk factors -smoking 12 , diabetes 13 , overweight 12, 14 -have been associated with hearing impairment both in cross-sectional 11, 13, 14 and longitudinal studies 10,12 . Lower levels of IGF-1 have been shown to be associated with elevated rates of cardiovascular disease 15 . Second, molecular data from animal studies suggest a role for IGF-1 in the development and protection of hearing function 16,17 . Rescue of hair cells from apoptosis via IGF-1 receptor-mediated actions or by downregulation of pro-apoptotic gene expression, and regulation of glucose transporters in the outer cells have been proposed as underlying mechanisms 18 . Third, we have recently shown that physical stature, which is related to IGF-1 levels 19,20 , is related to hearing impairment 21 , with taller individuals less likely to experience hearing loss, which is consistent with results of two other studies 22,23 . While lower height in itself is of course not a risk factor for hearing impairment, the pre-adult characteristics that it proxies -inadequate nutrition, illness and poverty -may be.