title: Cardiovascular Risk Factors and Ethnicity Are Independent Factors Associated with Lower Urinary Tract Symptoms.
abstract: OBJECTIVE
  To determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting.
  
  
  METHODS
  We conducted a cross-sectional study of 1021 men aged 40-79 years with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Potential factors associated with LUTS including age, ethnicity, education, history of hypertension, diabetes and hypercholesterolemia, height, weight, and prostate volume were evaluated using univariable and multivariable analyses.
  
  
  RESULTS
  There were 506 (50%) men found to have moderate-to-severe LUTS attaining an IPSS above 7. Overall, nocturia (45.5%) was the most frequently reported symptom. Multivariable analysis showed that age, ethnicity, prostate volume and history of hypertension and hypercholesterolemia were independent factors associated with severity of LUTS (p < 0.05). Considering individual lower urinary tract symptoms, we found a strong association of storage symptom with history of hypertension and hypercholesterolemia. Malay men were significantly bothered by post micturition symptom compared to their Chinese and Indian counterparts. Stratified analyses of LUTS demonstrated a mutually exclusive cardiovascular risk factors profile defined by ethnicity.
  
  
  CONCLUSIONS
  Severity of LUTS varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity and cardiovascular risk factors including hypertension and hypercholesterolemia may also need to be taken into account in managing men with LUTS.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Lim
authors.affiliation: Julius Center University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Primary Care, University Medical Center Utrecht, 3508GA, Utrecht, Netherlands.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Bhoo-Pathy
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Selvalingam
authors.initials: S
authors.lastname: Sothilingam
authors.affiliation: Department of Urology, Selayang Hospital, Selangor, Malaysia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Malek
authors.affiliation: Department of Urology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
authors.forename: Murali
authors.initials: M
authors.lastname: Sundram
authors.affiliation: Department of Surgery, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Guan Hee
authors.initials: GH
authors.lastname: Tan
authors.affiliation: Department of Surgery, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Badrulhisham
authors.initials: B
authors.lastname: Bahadzor
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Teng Aik
authors.initials: TA
authors.lastname: Ong
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, Australia.
authors.forename: Keng Lim
authors.initials: KL
authors.lastname: Ng
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Azad Hassan
authors.initials: AH
authors.lastname: Abdul Razack
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D002318:Cardiovascular Diseases / Q000473:pathology*; D003430:Cross-Sectional Studies; D005006:Ethnicity; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014554:Urination / Q000502:physiology