Objective: The purpose of this study was to explore the hypothesis that the relationship between hearing problems and cardiovascular disease (CVD) includes a connection to psychological distress. Design: We used generalized structural equation modeling to assess relationships between self-reported measures of hearing problems, psychological distress, and CVD in a pooled sample of 623,416 adult respondents in the 1997-2017 National Health Interview Survey. Hearing status without hearing aids was self-reported on an ordinal scale and further grouped for this study into 3 categories (excellent or good hearing, little or moderate trouble hearing, and a lot of trouble or deaf). Six CVDs (stroke, angina pectoris, hypertension, heart attack, coronary heart disease, or other heart condition/disease) were incorporated as a latent variable. Psychological distress was evaluated by the Kessler 6 Scale (Kessler et al., 2010). All estimates were population weighted, and standard errors were adjusted for a complex survey design. Results: Nearly 83% reported excellent or good hearing, 14% reported a little or moderate trouble hearing, and 3% reported a lot of trouble hearing or said they were deaf. Hearing problems were positively associated with CVD. Relative to those reporting excellent/good hearing, adults reporting trouble hearing had a higher probability of CVD. Hearing problems were also significantly associated with psychological distress. When psychological distress was applied to the model, positive associations between hearing problems and CVD were attenuated but still significant. Results are consistent with the hypothesis that the connection between self-reported hearing problems and CVD is mediated through psychological distress. Conclusions: The relationship between self-reported hearing problems and CVD is mediated by psychological distress. Further research is needed to identify causal pathways and psychophysiological mechanisms involved in this relationship and to identify effective methods for addressing cardiovascular health-related psychosocial factors in the treatment of hearing impairment.