title: Male Lower Urinary Tract Symptoms and Cardiovascular Events: A Systematic Review and Meta-analysis.
abstract: The correlation among metabolic syndrome, lower urinary tract symptoms (LUTS), and cardiovascular disease (CVD) is well established. In particular, CVD has been proposed as a potential risk factor for both LUTS progression and severity.
  
  
  
  To evaluate whether LUTS severity can be considered as a significant risk factor of major adverse cardiac events (MACE) in the male population.
  
  
  
  A systematic literature search was performed using PubMed, Google Scholar, and Scopus. The combination of the following keywords was adopted in a free-text strategy: benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) and cardiovascular, cardio, major adverse cardiac events, MACE, heart disease, heart, myocardial infarction, myocardial, infarction, stroke, ischemic events, ischemic, cardiac death, coronary syndrome. We included all cross-sectional and longitudinal trials enrolling men and comparing the prevalence or incidence of MACE in men with moderate to severe LUTS compared with those without LUTS or with mild LUTS. The studies in which only nocturia was evaluated were excluded from the analysis.
  
  
  
  Of 477 retrieved articles, 5 trials longitudinally reported the incidence of MACE in patients with moderate to severe LUTS in comparisons to those with mild or no LUTS and 10 studies reported the prevalence of history of MACE at enrollment. All were included in the present meta-analysis. Among cross-sectional studies, 38 218 patients and 2527 MACE were included in the meta-analysis. The mean age of enrolled patients was 62.2±8.0 yr. Presence of moderate to severe LUTS significantly increased the risk of reported history of MACE (p<0.001). Metaregression analyses showed that the risk of MACE was lower in older patients and higher in those with diabetes. The association between LUTS-related MACE and diabetes was confirmed in a multivariate regression model after adjusting for age (adjusted r=0.498; p<0.0001). Longitudinal trials included 25 494 patients and 2291 MACE. The mean age of enrolled patients was 52.5±5.5 yr, and mean follow-up was 86.8±22.1 mo. Presence of moderate to severe LUTS was associated with an increased incidence of MACE compared with the rest of the sample (odds ratio: 1.68; 95% confidence interval, 1.13-2.50; p=0.01).
  
  
  
  Men with moderate to severe LUTS seem to have an increased risk of MACE. A holistic approach in considering the morbidities of aging men should be strongly encouraged and represents an important role for the practicing urologist.
  
  
  
  We evaluated whether the severity of lower urinary tract symptoms could be considered as a significant risk factor for major adverse cardiac events (MACE) in the male population. We demonstrated that men with moderate to severe LUTS have an increased risk of MACE.
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. Electronic address: maurogacci@yahoo.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.affiliation: Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Arcangelo
authors.initials: A
authors.lastname: Sebastianelli
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.affiliation: Department of Urology, Sant'Andrea Hospital, University "La Sapienza", Rome, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.affiliation: Andrology Unit, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
authors.affiliation: Andrology Unit, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Vignozzi
authors.affiliation: Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: McVary
authors.affiliation: Department of Urology, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kaplan
authors.affiliation: Department of Urology, University Hospital of Larissa, Larissa, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.affiliation: Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chapple
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D018450:Disease Progression; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011470:Prostatic Hyperplasia / Q000150:complications*; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Benign prostatic enlargement; Benign prostatic hyperplasia; Lower urinary tract symptoms; Major cardiac adverse event; Prostate