Men with even mild lower urinary tract symptoms are at an increased risk of developing components of cardiometabolic disorders.
Nearly 25% of U.S. adults have a constellation of abnormalities that can be classified as cardiometabolic disorders (CMD): central adiposity, lipid disorders, hypertension, and elevated blood glucose. The cumulative effect is atherosclerotic plaque and, ultimately, cardiovascular disease. But research has shown that the effects of CMD extend beyond the heart, and may even include the genitourinary system. This article, the second in a three-part series, discusses new research on the association between CMD and lower urinary tract symptoms. It is part of a coordinated, interdisciplinary initiative prepared by the ModernMedicine Network of 17 health care publications ( http://www.modernmedicine.com/), including Urology Times. Look for the final article in this series in our November issue.
"We're probably not doing it enough, and we're not doing it early enough," said Kevin T. McVary, MD, professor of urology at Northwestern University, Chicago. "We need to intervene much earlier."
Elements of CMD were found in 29% of the study group, and 19.3% of the population had moderate to severe LUTS (AUASI of 8 or higher). Of those with mild LUTS (AUASI 2 to 7), 40% also met the criteria for cardiometabolic disorders.
Breaking down the findings by symptom, cardiometabolic disorders were associated with mild/severe incomplete emptying, intermittency, and nocturia. A statistically insignificant association was found between CMD and severe urgency. No association was found between CMD and weak stream, straining, or frequency.
Associations between CMD and LUTS were stronger in men younger than 60 years of age.
"I think the explanation for that is that as men age, other things come into play that could also contribute to LUTS," Dr. McVary said.
The researchers recommend routine questioning of patients with aspects of CMDs regarding urologic symptoms such as intermittency, incomplete emptying, nocturia, and bother. They further recommend first-line medications such as alpha-blockers and phosphodiesterase type-5 inhibitors for managing voiding and sexual dysfunction symptoms in patients who have CMD and urologic disorders.
Lifestyle changes needed
Behavioral changes are needed to counter the tide of CMD-related urologic disease, according to Dr. McVary.
"This is really a lifestyle problem, and we need to approach our lifestyle in a better, more sensible fashion," he said. He stresses the importance of early intervention with these patients, and adds that he considers checking urine glucose levels in patients with erectile dysfunction or LUTS "part and parcel" of his workup.
"When these guys are massively obese and hypertensive and their lipids are high, if they start forming plaques and have myocardial infarctions and end-stage bladders, at that point we've kind of missed the boat," Dr. McVary said. "Those are men we're not going to be able to reverse. They're already committed to a shorter lifespan and probably a miserable lifespan."
The exact mechanism(s) at play in the relationship among LUTS, ED, and CMD needs to be investigated using in vitro models, animal models, and translational and clinical trial investigations, Dr. McVary noted.
Results from the study were published in the August issue of the Journal of Urology (2009; 182:616-24).
Cardiometabolic disorders and urologic disease represent a "perfect storm" of ailments, according to Kevin T. McVary, MD. Dr. McVary discusses the urologist's role in management. Tune in at: http://urologytimes.com/perfectstorm