Urology

Male lower urinary tract symptoms and cardiovascular events: a systematic review and meta-analysis

Gacci M, Corona G, Sebastianelli A, Serni S, De Nunzio C, Maggi M, Vignozzi L, Novara G, McVary KT, Kaplan SA, Gravas S, Chapple C. Eur Urol 2016; Epub 20 Jul 2016

Risk of major cardiac adverse events in males with LUTS

There is a well-established correlation between lower urinary tract symptoms (LUTS), metabolic syndrome, and cardiovascular disease.1 It has been suggested that cardiovascular disease is a potential risk factor for the progression and severity of LUTS, and vice versa.1 A recent systematic review and meta-analysis published in European Urology investigated the correlation between LUTS severity and major adverse cardiac events (MACE) in males.1

In order to evaluate whether LUTS is a significant risk factor for MACE in the male population, Gacci and colleagues conducted a systematic review of PubMed, Google Scholar and Scopus databases.1 They included all published longitudinal or cross-sectional studies that compared the prevalence or incidence of MACE in men with moderate or severe LUTs to men without or with only mild LUTS.1

MACE was defined as:1

• Angina pectoris
• Acute myocardial infarction
• Other chronic ischemic heart disease
• Transient ischemic attack
• Cerebrovascular accident.

Studies included in the analysis comprised five longitudinal incidence studies and 10 studies reporting the prevalence of a history of MACE at enrollment.1

Meta-analysis of cross-sectional studies

In the cross-sectional studies, the meta-analysis included data from 38,218 patients (mean age 62.2±8.0 years) and 2,527 MACE.1 There was a significant association between presence of moderate-to-severe LUTS and an increased prevalence of reported history of MACE (odds ratio [OR] 2.38; 95% confidence interval [CI]  2.56–3.07; p<0.001).1 

Men with moderate-to-severe LUTS may have an increased risk of MACE.1

Results of a meta-regression analysis indicated that the risk of LUTS-related MACE was high in patients with diabetes and low in older men.1 An age-adjusted multivariate regression model confirmed the association between LUTS-related MACE and diabetes (r=0.498; p<0.0001).1

The risk of LUTS-related MACE was high in men with diabetes mellitus.1

Meta-analysis of longitudinal studies

Overall, 25,494 men (mean age 52.5±5.5 years) and 2,291 MACE were included in the meta-analysis of longitudinal trials.1 Compared to men without or only mild LUTS, the presence of moderate or severe LUTS was associated with an increased incidence of MACE (OR 1.68; 95% CI 1.13–2.50; p=0.01).1

Conclusions

The investigators concluded that men with LUTS have an increased risk of MACE, likely because they share similar contributing factors.1 Furthermore, the results of this meta-analysis indicated that as the prevalence of diabetes increased, the risk of LUTS-associated MACE also increased.1 However, further longitudinal studies are required to confirm these associations.1

The investigators also suggested these findings may have several clinical implications, including:1

• Prevention in men at risk of both heart disease an urinary symptoms, by redefining the role of diet and physical activity
• Diagnosis by screening for cardiovascular disease in men with LUTS, and vice versa
• Treatment by promoting a multi-disciplinary approach for men with comorbid metabolic syndrome, LUTS and cardiovascular disease.

Moderate to severe LUTS may be considered as a sentinel marker for heart disease and diabetes.1

Report on: Male lower urinary tract symptoms and cardiovascular events: a systematic review and meta-analysis. Gacci M, Corona G, Sebastianelli A, Serni S, De Nunzio C, Maggi M, Vignozzi L, Novara G, McVary KT, Kaplan SA, Gravas S, Chapple C. Eur Urol 2016; Epub 20 Jul 2016.