title: Greater endothelial dysfunction and arterial stiffness in men with chronic prostatitis/chronic pelvic pain syndrome--a possible link to cardiovascular disease.
abstract: OBJECTIVE
  Men with chronic prostatitis/chronic pelvic pain syndrome have higher self-reported rates of cardiac disease than controls. Peripheral arterial tone abnormalities correlate with cardiac disease and mortality. We studied vascular dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome and controls.
  
  
  METHODS
  A total of 21 men with chronic prostatitis/chronic pelvic pain syndrome and 14 asymptomatic controls were tested with an Endo-PAT®2000 machine which assessed the augmentation index, a measure of arterial stiffness, and reactive hyperemia index, a measure of endothelial vasodilation. Symptoms were measured with the National Institutes of Health Chronic Prostatitis Symptom Index and patient phenotype was characterized by the UPOINT (Urinary, Psychosocial, Organ Specific, Infection, Neurologic/Systemic, Tenderness of Skeletal Muscles) system. Statistical significance was set at p<0.05.
  
  
  RESULTS
  Age was similar in the chronic prostatitis/chronic pelvic pain syndrome group (range 22 to 63 years, median 40) and controls (range 19 to 57, median 40). Patients had median symptom duration of 24 months (range 3 to 440), a mean Chronic Prostatitis Symptom Index score of 24.7±5.1 and mean UPOINT domains of 2.9±1.1 (range 1 to 5). The augmentation index was significantly higher (greater arterial stiffness) in patients with chronic pelvic pain syndrome vs controls (5.0%±2.3 vs -6.0%±3.0, p=0.006). The reactive hyperemia index was significantly lower (more endothelial dysfunction) in patients with chronic pelvic pain syndrome (1.76±1.2 vs 2.21±1.7, p=0.03). There was no correlation between symptom duration, severity or phenotype (number or type of UPOINT domains) and reactive hyperemia index or augmentation index.
  
  
  CONCLUSIONS
  Men with chronic prostatitis/chronic pelvic pain syndrome have evidence of increased arterial stiffness and vascular endothelial dysfunction. This is the first mechanistic correlation found that links the higher incidence of self-reported cardiac disease in these patients. Noninvasive Endo-PAT testing may allow stratification of cases of chronic prostatitis/chronic pelvic pain syndrome by vascular dysfunction, which may require specific treatment or at least further assessment of cardiac risk.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. dshoskes@mac.com
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Shoskes
authors.forename: Donna
authors.initials: D
authors.lastname: Prots
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Karns
authors.forename: Joi
authors.initials: J
authors.lastname: Horhn
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Shoskes
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011472:Prostatitis / Q000150:complications* / Q000503:physiopathology*; D014655:Vascular Resistance; D055815:Young Adult