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

PURPOSE: To describe the association between lower urinary tract symptoms (LUTS) and cardiovascular diseases (CVD), with adjustment for age and other confounders. We were specifically interested in the possible predictive value of LUTS to the incidence of CVD in the future in the general population. METHODS: We performed post hoc analyses using data from the Krimpen study, a large community-based study in the Netherlands. All men aged 50-75 years, without prostate or bladder cancer, a history of radical prostatectomy, or neurogenic bladder disease, were invited to participate for a response rate of 50%. At baseline, 1,610 men were included. CVD status was compared to LUTS category, using logistic regression, providing odds ratios with 95% confidence intervals (OR 95% CI). For the longitudinal analyses in men without CVD at baseline, hazard ratios (HR) and 95% CI were estimated using Cox proportional hazard models with the occurrence of a CVD as outcome variable. RESULTS: At baseline, 362 men (22%) had a history of CVD. The ORs for CVD for men with moderate to severe LUTS were 2.04 (unadjusted, 95% CI 1.58-2.63), 1.86 (1.43-2.41, adjusted for age), and 1.81 (1.38-2.37, adjusted for age and other confounders). Of the 1,248 CVD-free men, 58 (4.6%) had a CVD event. HRs for moderate to severe LUTS were 0.98 (95% CI 0.52-1.86, unadjusted) and 1.08 (0.57-2.07, adjusted for age, obesity, hypertension, and erectile dysfunction). CONCLUSIONS: The cross-sectional analyses revealed a clear correlation between moderate to severe LUTS and CVD. In longitudinal analyses, however, no significant association was shown.

Are lower urinary tract symptoms in men associated with cardiovascular diseases in a primary care population: a registry study.

BACKGROUND: Although lower urinary tract symptoms (LUTS) seem to be related to cardiovascular disease (CVD) in men, it is unclear whether this relationship is unbiased. In order to investigate this relationship, we used longitudinal data for establishing the possible predictive value of LUTS for the development of CVD in a primary care population. METHODS: We performed a registry study using data from the Registration Network Groningen (RNG). All data from men aged 50 years and older during the study period from 1 January 1998 up to 31 December 2008 were collected. Cox proportional hazard regression analysis was used to determine the association between the proportions of CVD (outcome) and LUTS in our population. RESULTS: Data from 6614 men were analysed. The prevalence of LUTS increased from 92/1000 personyears (py) in 1998 up to 183/1000 py in 2008. For cardiovascular diseases the prevalence increased from 176/1000 py in 1998 up to 340/1000 py in 2008. The incidence numbers were resp. 10.2/1000 py (1998) and 5.1/1000 py (2008) for LUTS, and 12.9/1000 py (1998) and 10.4/1000 py (2008) for CVD. Of all men, 23.2% reported CVD (41.1% in men with LUTS vs 19.5% in men without LUTS, p < 0.01). The hazard ratio of LUTS for cardiovascular events, compared to no LUTS, in the adjusted multivariate model, was 0.921(95% CI: 0.824 - 1.030; p = 0.150). CONCLUSION: Based on the results, LUTS is not a factor that must be taken into account for the early detection of CVD in primary care.

Correlations between lower urinary tract symptoms, erectile dysfunction, and cardiovascular diseases: are there differences between male populations from primary healthcare and urology clinics? A review of the current knowledge.

OBJECTIVE: To evaluate the correlation between lower urinary tract symptoms, erectile dysfunction, and cardiovascular diseases in different male populations. DATA SOURCES: PubMed (Medline), clinical evidence, Embase, Cochrane reviews, and articles from reference lists. SELECTION CRITERIA: SELECTION CRITERIA in search databases were lower urinary tract symptoms, LUTS, comorbidity (MeSH), impotence (MeSH), sexual dysfunction, aging, primary care (MeSH), and male. Studies on these subjects, and concerning men aged 40 years or older, were eligible for inclusion in this review. Both community-based and clinical-based studies were included. RESULTS: 20 studies were eligible for inclusion, representing 71,322 men. These studies showed a significant positive correlation between lower urinary tract symptoms and erectile dysfunction. The odds ratios varied from 1.4 to 9.74. All studies were community or clinical based. Just one study based on a primary care population was described. The association between erectile dysfunction and cardiovascular diseases is not proven in primary care. CONCLUSIONS: The evidence of a positive correlation between lower urinary tract symptoms and erectile dysfunction is significant in community- and clinical-based studies. It is at present unknown whether these correlations are significant in the patient population of primary healthcare. We need more evidence to prompt the general practitioner to screen every man with initial presentation of erectile dysfunction for standard cardiovascular risk factors and, as appropriate, start initial cardioprotective interventions.