Dr. Kaplan, a member of the Urology Times Editorial Council, is E. Darracott Vaughan Jr. Professor of Urology at Weill Cornell Medical College and and director of the Iris Cantor Men’s Health Center, New York Presbyterian Hospital, New York.
"LUTS is an important health care burden, and health care professionals should be screening for its presence in men at risk," writes Steven A. Kaplan, MD.
|Steven A. Kaplan, MD||Dr. Kaplan,|
When health economists evaluate therapies and interventions, concepts such as burden of disease, health-related quality of life, and downstream economic factors are analyzed. While BPH is a big-ticket item for the field of urology, is it a big deal to the population at large? Does it have a substantial effect in a substantial group of men at risk?
In a study discussed in the September 2016 issue of Urology Times, the authors evaluated the correlation with lower urinary tract symptoms (LUTS) and major adverse cardiac events (MACE). Employing an extensive literature search and meta-analysis, more than 25,000 men including 2,291 with MACE were evaluated. In this group of men (mean age, 52.5±5.5 years), moderate to severe LUTS was associated with a significantly increased incidence of MACE.
What is the significance of these findings? The association between MACE and LUTS has been established in many populations. Is there a common etiologic factor? Various hypotheses have been proposed, including vascular, nerve and endothelial damage, an alteration of smooth muscle tone and an arterial insufficiency leading to reduced blood flow and hypoxia, and a downstream cascade of inflammatory factors.
In a study of National Health and Wellness Survey data in 2011 and 2012, a significant health burden as well as correlation to cardiovascular disease was found. Much of this was related to nocturia (which was excluded from the MACE analysis).
One limitation of this study is that the association between LUTS and cardiac events may be a self-fulfilling prophecy, i.e., men with moderate/severe LUTS and MACE are more likely to seek health care.
Other confounding variables that were not analyzed include family history, diet, tobacco and drug use, and physical activity, as well pertinent comorbidities including depression.
The bottom line is that LUTS is an important health care burden and that health care professionals should be screening for the presence of LUTS in men at risk.
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