Are lower urinary tract symptoms associated with cardiovascular disease in the Dutch general population? Results from the Krimpen study

PurposeTo describe atherosclerosis may lead to chronic bladder ischemia, eventually resulting in lower urinary tract syndrome (LUTS), and peripheral arterial occlusive disease (PAOD). We investigated the association of LUTS with PAOD.MethodsThis nationwide population-based cohort study was based on data from the Taiwan National Health Insurance Database from 2000 to 2010; follow-up lasted until the end of 2011. We identified patients with newly diagnosed LUTS by using International Classification of Diseases, Ninth Revision, Clinical Modification codes.ResultsIn total, 36,042 and 36,042 patients were enrolled in LUTS and non-LUTS cohorts, respectively. After adjustment for age, sex, and comorbidities, the risk of subsequent PAOD was 1.36-fold higher [95% confidence interval (CI) = 1.26–1.46] in the LUTS cohort than in the non-LUTS cohort. The adjusted risk of PAOD was the highest in patients with LUTS without any comorbidity [adjusted hazard ratio (aHR) = 1.93, 95% CI = 1.54–2.41]. The age-specific relative risk of PAOD was significantly higher in all age groups, particularly in those aged <49 years (aHR = 1.80, 95% CI = 1.39–2.34], in the LUTS cohort than in the non-LUTS cohort.ConclusionLUTS is a risk factor for PAOD. Physicians should consider the possibility of underlying PAOD in patients with LUTS aged <49 years and without cardiovascular comorbidities. Additional studies developing strategies for decreasing the risk of PAOD are warranted.

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“…LUTS is perhaps undercoded because it is a symptom diagnosis. Thus, this error might underestimate the effect of LUTS on subsequent PAOD [24]. …”

Section: Discussionmentioning

confidence: 99%

“…However, the use of ICD-CM-9 codes for diagnosing chronic diseases has been validated in previous national cohort studies [10, 24, 33–35]. The NHIRD covers a highly representative sample of Taiwan’s general population because the reimbursement policy is universal and operated by a single-buyer, the government in Taiwan.…”

Section: Discussionmentioning

confidence: 99%

Association of lower urinary tract syndrome with peripheral arterial occlusive disease

et al. 2017

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“…The Boston Area Community Health Survey and Third National Health and Nutrition Examination Survey showed the relationship between LUTS and metabolic syndrome . In addition, several studies have shown that LUTS is associated with an increase in the prevalence of cardiovascular events, although there were differences in the methodology used for statistical analysis in these studies . In contrast, Bouwman et al .…”

Section: Introductionmentioning

confidence: 99%

“…25,26 In addition, several studies have shown that LUTS is associated with an increase in the prevalence of cardiovascular events, although there were differences in the methodology used for statistical analysis in these studies. [27][28][29][30][31][32][33][34][35][36] In contrast, Bouwman et al reported that LUTS is not an independent predictor of cardiovascular events in men without a history of CVD, whereas an association between LUTS and cardiovascular events has been shown by cross-sectional studies. 37 It remains unclear whether LUTS/BPH is an independent predictor of cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

Lower urinary tract symptoms/benign prostatic hypertrophy and vascular function: Role of the nitric oxide–phosphodiesterase type 5–cyclic guanosine 3′,5′‐monophosphate pathway

Higashi

2017

Int J of Urology

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It is well known that there is an association of lower urinary tract symptoms/ benign prostatic hypertrophy with cardiovascular disease, suggesting that lower urinary tract symptoms/benign prostatic hypertrophy is a risk factor for cardiovascular events. Vascular function, including endothelial function and vascular smooth muscle function, is involved in the pathogenesis, maintenance and development of atherosclerosis, leading to cardiovascular events. Vascular dysfunction per se should also contribute to lower urinary tract symptoms/benign prostatic hypertrophy. Both lower urinary tract symptoms/benign prostatic hypertrophy and vascular dysfunction have cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes mellitus, aging, obesity and smoking. Inactivation of the phosphodiesterase type 5-cyclic guanosine 3 0 ,5 0 -monophosphate-nitric oxide pathway causes lower urinary tract symptoms/benign prostatic hypertrophy through an enhancement of sympathetic nervous activity, endothelial dysfunction, increase in Rho-associated kinase activity and vasoconstriction, and decrease in blood flow of pelvic viscera. Both endogenous nitric oxide and exogenous nitric oxide act as vasodilators on vascular smooth muscle cells through an increase in the content of cyclic guanosine 3 0 ,5 0 -monophosphate, which is inactivated by phosphodiesterase type 5. In a clinical setting, phosphodiesterase type 5 inhibitors are widely used in patients with lower urinary tract symptoms/benign prostatic hypertrophy. Phosphodiesterase type 5 inhibitors might have beneficial effects on vascular function through not only inhibition of cyclic guanosine 3 0 ,5 0 -monophosphate degradation, but also increases in testosterone levels and nitric oxide bioavailability, increase in the number and improvement of the function of endothelial progenitor cells, and decrease in insulin resistance. In the present review, the relationships between lower urinary tract symptoms/benign prostatic hypertrophy, the phosphodiesterase type 5-nitric oxidecyclic guanosine 3 0 ,5 0 -monophosphate pathway, vascular function and cardiovascular outcomes are examined.Key words: benign prostatic hypertrophy, lower urinary tract symptoms, nitric oxide, phosphodiesterase type 5-cyclic guanosine 3 0 ,5 0 -monophosphate, vascular function.

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“…Taken into account these premises, it should be noted that all previous pathogenetic mechanisms are known to increase cardiovascular disease (CVD) risk [12].…”

mentioning

confidence: 99%

Benign prostatic hyperplasia and metabolic syndrome: the expanding evidences of a new disease of aging male

2015

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Are lower urinary tract symptoms associated with cardiovascular disease in the Dutch general population? Results from the Krimpen study

Abstract: The cross-sectional analyses revealed a clear correlation between moderate to severe LUTS and CVD. In longitudinal analyses, however, no significant association was shown.

Cited by 21 publications

References 27 publications

Association of lower urinary tract syndrome with peripheral arterial occlusive disease

Association of lower urinary tract syndrome with peripheral arterial occlusive disease

Lower urinary tract symptoms/benign prostatic hypertrophy and vascular function: Role of the nitric oxide–phosphodiesterase type 5–cyclic guanosine 3′,5′‐monophosphate pathway

Benign prostatic hyperplasia and metabolic syndrome: the expanding evidences of a new disease of aging male

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