AbstractObjectiveThe role of ideal cardiovascular health (CVH) metrics in developing hearing loss remains uncertain. Thus, our objective was to analyse the connection between hearing loss and ideal CVH metrics in a 10‐year retrospective cohort.Study DesignRetrospective cohort study.SettingA health management centre in Taiwan.ParticipantsParticipants who underwent the first annual health check‐up between 2000 and 2006 and with a follow‐up check‐up more than ten years later.Main outcome measuresHearing thresholds were measured at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Individuals with a best ear pure‐tone audiometry four‐frequency average of >25 dB HL were defined as having hearing loss. The ideal CVH metrics were classified into 7 categories based on the American Heart Association's definition. The associations of hearing loss with the sum of the ideal CVH metrics and each ideal CVH metric were examined by multiple logistic regression analysis.ResultsThe present study consisted of 6974 participants. The 10‐year follow‐up showed that the odds ratio (OR) of hearing loss was .74 for participants with 5–7 ideal CVH metrics (95% CI, .59–.93, p = .01) compared with those with 0–2 ideal CVH metrics. Among the CVH metrics, participants with an ideal smoking status might have reduced odds of developing hearing loss; the OR was .72 (95% CI, .58–.89, p = .003).ConclusionsParticipants with an increased number of ideal CVH metrics and better performance on the smoking metric had a significantly protective effect regarding hearing loss development.