Meta-analysis links LUTS to heart disease in men

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A new meta-analysis links moderate-to-severe lower urinary tract symptoms (LUTS) to heart disease in men, possibly because unhealthy lifestyles boost the risks of both conditions.

San Diego-A new meta-analysis links moderate-to-severe lower urinary tract symptoms (LUTS) to heart disease in men, possibly because unhealthy lifestyles boost the risks of both conditions.

Commentary: LUTS’ burden may extend to cardiac events

As a result of the research, “Moderate-to-severe LUTS can be considered as a sentinel marker for heart disease,” said co-author Arcangelo Sebastianelli, MD, of the department of urology at the University of Florence’s Careggi Hospital in Florence, Italy.

It’s still not clear whether one of the conditions causes the other or if a third factor, such as metabolic syndrome, has the biggest effect by boosting the risks of both.

“The components of the metabolic syndrome play a key role in the common pathophysiology of LUTS and cardiovascular disease,” Dr. Sebastianelli told Urology Times.

The authors reviewed 477 studies. They focused on two groups of studies. One group of five studies reported the incidence of major adverse cardiac events in patients with moderate-to-severe LUTS and compared them to patients with mild or no LUTS. Another group of 10 studies reported on the prevalence of these cardiac events at enrollment.

The findings were published online in European Urology (Aug. 20, 2016) after early results were reported at the AUA annual meeting in San Diego.

The longitudinal trials included 25,494 men and 2,291 with cardiac events. The mean age of enrolled patients was 52.5±5.5 years, and mean follow-up was 86.8±22.1 months.

The meta-analysis found that men with moderate-to-severe LUTS were more likely than the other subjects to develop major adverse cardiac events (OR: 1.68, 95%CI: 1.13-2.50, p=.01).

Cross-sectional studies included 38,218 patients and 2,527 with cardiac events; the average age was 62.2±8.0 years. Again, a meta-analysis linked moderate-to-severe LUTS to a significantly higher reported history of the cardiac events. Meta-regression analyses found a lower risk of the events in older patients and a higher risk in diabetics.

Next: Do metabolic components play role?

Do metabolic components play role?

Discussing possible reasons for the findings, Dr. Sebastianelli points to risk factors for both conditions that are linked to metabolic syndrome in men.

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“In particular, higher triglyceride and cholesterol levels seem to have a detrimental effect on prostatic cells, boosting prostate inflammation, which can be associated with the development and progression of LUTS due to benign prostate hyperplasia,” he said. “Similarly, insulin resistance, dyslipidemia, and hypertension are proven to be strong determinants for the development of cardiovascular disease.”

Dr. Sebastianelli adds that LUTS can affect the risk of cardiac disease by disrupting quality of life.

“The increased stress and anxiety resulting from severe LUTS, often associated with poor sleep quality, could lead to a significant increase in cardiovascular risk,” he said.

What about the possibility that heart disease directly boosts the risk of LUTS?

“For the lack of data, we couldn’t evaluate if cardiac illness can boost the risk of LUTS,” Dr. Sebastianelli said. But previous research has “demonstrated that coronary heart disease can independently increase the risk for development of clinical benign prostate hyperplasia over 9 years.”

What’s next? “The findings of our review may play a role in disease prevention, redefining the role of lifestyle-diet and physical activity-for men at risk of both urinary symptoms and heart disease,” he said.

In addition, it may make sense to screen men with LUTS for cardiovascular disease and vice versa, he says. Finally, he says, there may value to “promoting a holistic approach among general practitioners, urologists, endocrinologists, and cardiologists for men with comorbid metabolic syndrome, LUTS, and cardiovascular disease.”