Date Published: March 16, 2017
Publisher: Public Library of Science
Author(s): Wei-Yu Lin, Karl-Erik Andersson, Cheng-Li Lin, Chia-Hung Kao, Hsi-Chin Wu, Giovanni Li Volti.
To describe atherosclerosis may lead to chronic bladder ischemia, eventually resulting in lower urinary tract syndrome (LUTS), and peripheral arterial occlusive disease (PAOD). We investigated the association of LUTS with PAOD.
This nationwide population-based cohort study was based on data from the Taiwan National Health Insurance Database from 2000 to 2010; follow-up lasted until the end of 2011. We identified patients with newly diagnosed LUTS by using International Classification of Diseases, Ninth Revision, Clinical Modification codes.
In total, 36,042 and 36,042 patients were enrolled in LUTS and non-LUTS cohorts, respectively. After adjustment for age, sex, and comorbidities, the risk of subsequent PAOD was 1.36-fold higher [95% confidence interval (CI) = 1.26–1.46] in the LUTS cohort than in the non-LUTS cohort. The adjusted risk of PAOD was the highest in patients with LUTS without any comorbidity [adjusted hazard ratio (aHR) = 1.93, 95% CI = 1.54–2.41]. The age-specific relative risk of PAOD was significantly higher in all age groups, particularly in those aged <49 years (aHR = 1.80, 95% CI = 1.39–2.34], in the LUTS cohort than in the non-LUTS cohort. LUTS is a risk factor for PAOD. Physicians should consider the possibility of underlying PAOD in patients with LUTS aged <49 years and without cardiovascular comorbidities. Additional studies developing strategies for decreasing the risk of PAOD are warranted.
In 2008, approximately 45.2% of the worldwide population (4.3 billion) was affected by at least one lower urinary tract syndrome (LUTS) . Patients with LUTS seeking medical help increased annually from 2000 to 2009 in Taiwan .
The distribution of sex, age, and comorbidities in both cohorts is presented in Table 1. Among 36042 patients with LUTS, over 98.7% of patients with LUTS (n = 35584) were on treatment. No statistical difference was observed in the distribution of sex, age, and comorbidities between the cohorts, except for heart failure and asthma. The mean age of patients in LUTS and non-LUTS cohorts was 59.9 ± 15.0 and 59.4 ± 14.8 years, respectively. In both cohorts, most patients were men (71.1%) and aged >65 years (41.6%). Furthermore, in both cohorts, the major comorbidity was hypertension (47.7%), followed by hyperlipidemia (25.3%), stroke (23.7%), and CAD (23.0%). The average follow-up period (years) in LUTS and non-LUTS cohorts was 6.55 and 6.47 years, respectively (data not shown). The cumulative incidence of PAOD was higher in the LUTS cohort than in the non-LUTS cohort (Fig 1).
PAOD is one of the most fatal diseases; however, it is often ignored [9, 16]. Even without a history of ischemic stroke or myocardial infarction, patients with PAOD have the same risk of death as do patients with related cardiovascular disease (CVD) [10, 17–19]. LUTS is considered the initial manifestation of underlying PAOD. Diabetes could be as crucial link between LUTS and PAOD because the close association between LUTS vs. diabetes and diabetes vs. PAOD have been recognized [20, 21]. Identification of a predictive symptom can allow early intervention and thus decrease complications resulting from the disease . This can be extremely crucial for patients without regular and adequate medical assessments of CVD risk factors .
This nationwide population-based cohort study indicated that LUTS is associated with subsequent PAOD, particularly in patients aged <49 years and without cardiovascular comorbidities. Physicians should consider the possibility of PAOD in patients with LUTS. Additional studies on disease screening and early intervention are warranted to prevent the subsequent complications of PAOD in patients with LUTS. Source: http://doi.org/10.1371/journal.pone.0170288