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Are Lower Urinary Tract Symptoms Linked to Incidence of Type 2 Diabetes and Heart Disease?

Occurrence of lower urinary tract symptoms might be a useful predictor…

There has been increasing evidence suggesting an association of cardiovascular and metabolic risk factors with Lower Urinary Tract Symptoms (LUTS). An increased likelihood of LUTS with decreased physical activity and increased obesity has been reported in studies. An association of LUTS has also been made with components of metabolic syndrome, such as a low level of high density lipoprotein and increased glucose. Increased severity of urinary symptoms with type 2 diabetes have also been reported in older men.

This study was a population based cohort study of urological symptoms in men and women. A stratified 2-stage cluster sampling design was used to recruit a random community based sample of 2,301 men and 3,201 women 30 to 79 years old from a total of 3 racial/ethnic groups in Boston, Massachusetts. Lower urinary tract symptoms were assessed by the American Urological Association symptom index AUA-SI), and voiding and storage sub-scores. AUA-SI was used as a continuous variable and categorized as no/mild symptoms (AUA-SI less than 8) vs moderate/severe symptoms (AUA-SI 8 or greater). Logistic regression was used to estimate the OR and 95% CI, and adjust for potential confounders. Participants completed an in-person interview at baseline and approximately 5 years later. The study used longitudinal data from BACH to determine whether baseline LUTS could predict Type 2 diabetes (T2D) or heart disease (HD) 5 years after baseline in the study population at risk.

The prevalence of type 2 diabetes and heart disease at baseline was 7.0% (370 cases) and 8.3% (537), respectively. A BMI ≥30 kg/m2 and abdominal obesity were strongly associated with incidence of type 2 diabetes. No difference was noted in incidence or association of LUTS with T2D or HD by gender (P=0.597 and P=0.502). There were 217 new cases of T2D for an overall 3.5% incidence. The incidence was higher for moderate to severe LUTS (AUA-SI 8 or greater) vs no/mild symptoms (5.9% vs 3.0%). In subjects with a BMI of ≥30 kg/m2 the adjusted ORs for incidence of heart disease were 1.89 (95% CI 1.05 to 3.39) for AUA-SI 8 or greater and 2.32 (95% CI 1.33 to 4.05) for a storage score of 4 or greater. In subjects with abdominal obesity the adjusted ORs for incidence of type 2 diabetes were 2.06 (95% CI 1.19 to 3.55) for AUA-SI 8 or greater and 1.81 (95% CI 1.04 to 3.15) for a storage score of 4 or greater. Lower urinary tract symptoms (AUA-SI 8 or greater) were also predictive of type 2 diabetes in both men and women who were younger than 50 years of age (adjusted OR 2.37, 95% CI 1.18 to 4.80). Voiding and storage symptom sub-scores were used as continuous variables, (5 or greater for voiding symptoms and 4 or greater for storage symptoms).

Results from the longitudinal population based study showed that LUTS is a predictor of incidence of T2D and HD in obese men and women. The results appeared to be associated more with storage rather than voiding symptoms. Storage symptoms were more strongly and consistently associated with an increased risk of disease. Finally, LUTS was shown to be associated with an increased risk of earlier T2D onset in younger subjects (less than 50 years of age).

Practice Pearls:

  • An inverse relationship between lower urinary tract symptoms and physical activity and obesity has been seen and reported.
  • Baseline data showed a cross-sectional association of LUTS (AUA-SI 8 or greater) with T2D in men but not in women.
  • Urgency in men and nocturia in women were reported to be associated with approximately a two-fold increase in the odds of T2D in the BACH series.

Varant Kupelian, Andre B. Araujo, Gary A. Wittert, John B. McKinlay. “Association of Moderate to Severe Lower Urinary Tract Symptoms with Incident Type 2 Diabetes and Heart Disease”. The Journal of Urology. 2015; Vol. 193, 581-586, February 2015