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Nocturia is Associated with High Atherosclerotic Cardiovascular Disease Risk in Women: Results from the National Health and Nutrition Examination Survey

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Abstract

Growing evidence has identified nocturia as a potential manifestation of several cardiovascular disease states. We aimed to determine whether a relationship exists between nocturia and global atherosclerotic cardiovascular disease (ASCVD) risk, defined by the American College of Cardiology/American Heart Association (ACC/AHA) ASCVD risk calculator, using a large nationally-representative study sample from the United States. We explored potential associations between nocturia and ASCVD risk in adults aged 40–79 years with no prior history of overt/known atherosclerotic disease from 7 consecutive cycles of the National Health and Nutrition Examination Survey. Subjects were classified by whether they met the ASCVD high-risk threshold following current ACC/AHA consensus guidelines (10-year major adverse cardiovascular event risk ≥ 20%). Logistic regression analyses were used to explore associations between nocturia (defined as ≥ 2 nocturnal voids) and ASCVD risk. The prevalence of nocturia and high ASCVD risk were 27.0% and 10.9%, respectively. Nocturia, older age, increased body mass index, and diuretic use were associated with high ASCVD risk on univariate logistic regression. After adjusting for age, body mass index, and diuretic use, nocturia remained associated with significantly greater odds of high ASCVD risk in females but not in males. Elicitation of nocturia on clinical history taking may serve to identify high cardiovascular risk in females. Future studies are needed to elucidate mechanisms underlying this association.

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References

  1. Everaert, K., Anderson, P., Wood, R., Andersson, F. L., & Holm-Larsen, T. (2018). Nocturia is more bothersome than daytime LUTS: Results from an Observational, Real-life Practice Database including 8659 European and American LUTS patients. International Journal of Clinical Practice, 72(6), e13091. https://doi.org/10.1111/ijcp.13091.

    Article  PubMed  Google Scholar 

  2. Irwin, D. E., Milsom, I., Hunskaar, S., et al. (2006). Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: Results of the EPIC study. European Urology, 50(6), 1306–1314; discussion 1314–1305. https://doi.org/10.1016/j.eururo.2006.09.019.

    Article  PubMed  Google Scholar 

  3. Bosch, J. L., & Weiss, J. P. (2013). The prevalence and causes of nocturia. Journal of Urology, 189(1 Suppl), S86-92. https://doi.org/10.1016/j.juro.2012.11.033.

    Article  Google Scholar 

  4. Asplund, R., & Aberg, H. E. (2004). Nocturia in relation to body mass index, smoking and some other life-style factors in women. Climacteric, 7(3), 267–273. https://doi.org/10.1080/13697130400001398.

    Article  CAS  PubMed  Google Scholar 

  5. Kim, S. Y., Bang, W., Kim, M. S., Park, B., Kim, J. H., & Choi, H. G. (2017). Analysis of the prevalence and factors associated with nocturia in adult Korean men. Scientific Reports, 7, 41714. https://doi.org/10.1038/srep41714.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kupelian, V., Fitzgerald, M. P., Kaplan, S. A., Norgaard, J. P., Chiu, G. R., & Rosen, R. C. (2011). Association of nocturia and mortality: Results from the Third National Health and Nutrition Examination Survey. Journal of Urology, 185(2), 571–577. https://doi.org/10.1016/j.juro.2010.09.108.

    Article  Google Scholar 

  7. Goff, D. C., Lloyd-Jones, D. M., Bennett, G., et al. (2014). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 63(25, Part B), 2935–2959. https://doi.org/10.1016/j.jacc.2013.11.005.

    Article  PubMed  Google Scholar 

  8. Bouwman, I. I., Voskamp, M. J. H., Kollen, B. J., Nijman, R. J. M., van der Heide, W. K., & Blanker, M. H. (2015). Do lower urinary tract symptoms predict cardiovascular diseases in older men? A systematic review and meta-analysis. World Journal of Urology, 33(12), 1911–1920. https://doi.org/10.1007/s00345-015-1560-1.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Retrieved from https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Questionnaire. Accessed 1 Dec 2020.

  10. Arnett, D. K., Blumenthal, R. S., Albert, M. A., et al. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 74(10), 1376–1414. https://doi.org/10.1016/j.jacc.2019.03.009.

    Article  PubMed  Google Scholar 

  11. Monaghan, T. F., Gong, F., Vaysblat, M., et al. (2020). Nocturia: A marker of furosemide treatment response? An exploratory study. BJU International, 125(5), 636–637. https://doi.org/10.1111/bju.15017.

    Article  PubMed  Google Scholar 

  12. Markland, A. D., Vaughan, C. P., Johnson, T. M., 2nd., Goode, P. S., Redden, D. T., & Burgio, K. L. (2011). Prevalence of nocturia in United States men: Results from the National Health and Nutrition Examination Survey. Journal of Urology, 185(3), 998–1002. https://doi.org/10.1016/j.juro.2010.10.083.

    Article  Google Scholar 

  13. Hall, S. A., Chiu, G. R., Kaufman, D. W., Wittert, G. A., Link, C. L., & McKinlay, J. B. (2012). Commonly used antihypertensives and lower urinary tract symptoms: Results from the Boston Area Community Health (BACH) Survey. BJU International, 109(11), 1676–1684. https://doi.org/10.1111/j.1464-410X.2011.10593.x.

    Article  PubMed  Google Scholar 

  14. Moon, S., Chung, H. S., Yu, J. M., et al. (2019). The association between obesity and the nocturia in the U.S. population. International Neurourology Journal, 23(2), 169–176. https://doi.org/10.5213/inj.1938062.031.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yoshimura, K. (2012). Correlates for nocturia: A review of epidemiological studies. International Journal of Urology, 19(4), 317–329. https://doi.org/10.1111/j.1442-2042.2011.02956.x.

    Article  PubMed  Google Scholar 

  16. Gacci, M., Corona, G., Sebastianelli, A., et al. (2016). Male lower urinary tract symptoms and cardiovascular events: A systematic review and meta-analysis. European Urology, 70(5), 788–796. https://doi.org/10.1016/j.eururo.2016.07.007.

    Article  PubMed  Google Scholar 

  17. Garcia, M., Mulvagh, S. L., Merz, C. N. B., Buring, J. E., & Manson, J. E. (2016). Cardiovascular disease in women: Clinical perspectives. Circulation Research, 118(8), 1273–1293. https://doi.org/10.1161/CIRCRESAHA.116.307547.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Weiss, J. P., Blaivas, J. G., Stember, D. S., & Chaikin, D. C. (1999). Evaluation of the etiology of nocturia in men: The nocturia and nocturnal bladder capacity indices. Neurourology and Urodynamics, 18(6), 559–565.

    Article  CAS  Google Scholar 

  19. Weiss, J. P., Blaivas, J. G., Stember, D. S., & Brooks, M. M. (1998). Nocturia in adults: Etiology and classification. Neurourology and Urodynamics, 17(5), 467–472.

    Article  CAS  Google Scholar 

  20. Colombo, P. C., Onat, D., & Sabbah, H. N. (2008). Acute heart failure as “acute endothelitis”—Interaction of fluid overload and endothelial dysfunction. European Journal of Heart Failure, 10(2), 170–175. https://doi.org/10.1016/j.ejheart.2007.12.007.

    Article  PubMed  Google Scholar 

  21. Inci, M., Sarli, B., Davarci, M., et al. (2013). Relationship between endothelial dysfunction and nocturia with benign prostatic hyperplasia. Scandinavian Journal of Urology, 47(5), 384–389. https://doi.org/10.3109/21681805.2012.762038.

    Article  PubMed  Google Scholar 

  22. Tabara, Y., Matsumoto, T., Murase, K., et al. (2019). Frequent nocturnal urination in older men is associated with arterial stiffness: The Nagahama study. Hypertension Research, 42(12), 1996–2001. https://doi.org/10.1038/s41440-019-0309-4.

    Article  PubMed  Google Scholar 

  23. Torimoto, K., Hirayama, A., Samma, S., Yoshida, K., Fujimoto, K., & Hirao, Y. (2009). The relationship between nocturnal polyuria and the distribution of body fluid: Assessment by bioelectric impedance analysis. Journal of Urology, 181(1), 219–224; discussion 224. https://doi.org/10.1016/j.juro.2008.09.031.

    Article  Google Scholar 

  24. Nomiya, M., Yamaguchi, O., Akaihata, H., et al. (2014). Progressive vascular damage may lead to bladder underactivity in rats. Journal of Urology, 191(5), 1462–1469. https://doi.org/10.1016/j.juro.2013.10.097.

    Article  Google Scholar 

  25. Landau, E. H., Jayanthi, V. R., Churchill, B. M., et al. (1994). Loss of elasticity in dysfunctional bladders: Urodynamic and histochemical correlation. Journal of Urology, 152(2 Pt 2), 702–705. https://doi.org/10.1016/s0022-5347(17)32685-x.

    Article  CAS  Google Scholar 

  26. Parsons, M., Amundsen, C. L., Cardozo, L., Vella, M., Webster, G. D., & Coats, A. C. (2007). Bladder diary patterns in detrusor overactivity and urodynamic stress incontinence. Neurourology and Urodynamics, 26(6), 800–806. https://doi.org/10.1002/nau.20406.

    Article  PubMed  Google Scholar 

  27. Smith, P. P., Chalmers, D. J., & Feinn, R. S. (2015). Does defective volume sensation contribute to detrusor underactivity? Neurourology and Urodynamics, 34(8), 752–756. https://doi.org/10.1002/nau.22653.

    Article  PubMed  Google Scholar 

  28. Pinggera, G. M., Mitterberger, M., Pallwein, L., et al. (2008). alpha-Blockers improve chronic ischaemia of the lower urinary tract in patients with lower urinary tract symptoms. BJU International, 101(3), 319–324. https://doi.org/10.1111/j.1464-410X.2007.07339.x.

    Article  CAS  PubMed  Google Scholar 

  29. Monaghan, T. F., Miller, C. D., Agudelo, C. W., et al. (2020). Cardiovascular risk independently predicts small functional bladder storage capacity. International Urology and Nephrology. https://doi.org/10.1007/s11255-020-02616-6.

    Article  PubMed  Google Scholar 

  30. Everaert, K., Herve, F., Bosch, R., et al. (2019). International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourology and Urodynamics, 38(2), 478–498. https://doi.org/10.1002/nau.23939.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

Authors

Contributions

Conceptualization: JML, MDC, TFM; Methodology: JML, MDC, TFM; Formal Analysis and Investigation: JML, MDC, TFM; Writing—Original Draft Preparation: JML, TFM; Writing—Review and Editing: JML, MDC, JPW, KE, TDB, AJW, FCB, TFM; Funding Acquisition: N/A; Resources: N/A; Supervision: AJW, FCB.

Corresponding author

Correspondence to Jason M. Lazar.

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Conflict of interest

Jason M. Lazar has no direct or indirect commercial incentive associated with publishing this article and certifies that all conflicts of interest relevant to the subject matter discussed in the manuscript are the following: Dr. Weiss is a consultant for Ferring and the Institute for Bladder and Prostate Research, outside the submitted work. Dr. Everaert is a consultant and lecturer for Medtronic and Ferring and reports institutional grants from Allergan, Ferring, Astellas, and Medtronic, outside the submitted work. Dr. Wein has served as an advisor/consultant for Bulkamid, Medtronic, Serenity, Urovant, and Velicept, outside the submitted work. The additional authors have nothing to disclose.

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The present analysis employed data from a publicly-available dataset and did not require approval from an ethical committee.

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Lazar, J.M., Chobufo, M.D., Weiss, J.P. et al. Nocturia is Associated with High Atherosclerotic Cardiovascular Disease Risk in Women: Results from the National Health and Nutrition Examination Survey. J Community Health 46, 854–860 (2021). https://doi.org/10.1007/s10900-021-00962-9

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