Association Between Coronary Artery Disease Severity and Overactive Bladder in Geriatric Patients: Beyond the Abstract

Atherosclerosis is one of the main causes of increasing coronary artery disease (CAD) and it causes impaired microcirculatory function, endothelial dysfunction, increased arterial stiffness and discrete plaque formation within the arterial walls. Since atherosclerosis involves coronary arteries as a systemic disease, it affects several vessels in the body.Recently, a close relationship was investigated between pelvic ischemia and lower urinary tract symptoms (LUTS). LUTS include OAB symptoms (e.g. nocturia, frequency, and urgency with or without urgency urinary incontinence). CAD remains the leading cause of death of individuals aged 65 years and older. There is also a higher incidence of OAB responsible for additional causes of death due to a higher rate of falls and fractures in this age group.The aim of this study was to demonstrated the correlation between OAB and the severity of coronary artery stenosis.

Patients presenting with cardiac symptoms were evaluated in the Cardiology Polyclinic by a single cardiologist.The decision for coronary angiography was made for all patients for whom it was seen to be necessary as a result of the patient history, physical examination and imaging results. Each participant was asked about detailed medical history and then completed the OAB-V8 questionnaire. Smoking, BMI, and levels of BUN, cholesterol, triglyceride, HDL, LDL, glucose, urinalysis, urine culture, uroflowmetry, ultrasound, bladder frequency volume diary and postvoiding residual volume were measured.The patients were divided into two groups based on the severity of OAB symptoms assessed by OAB-V8 questionnaire. Group 1 (OAB) comprised those with a score ≥8 and Group 2 (non-OAB), those with a score <8. Patients who met the study criteria and who completed the OAB-V8 form underwent coronary angiography within 2 weeks. The formal stratification of plaque burden was assessed by calculation of a Gensini score for each patient.

Of 358 patients, 308 patient who met the inclusion criteria were analyzed prospectively. A total of 50 patients were excluded from the study. The mean age, cholesterol and LDL levels of the patients in the OAB group were found to be significantly higher than those of the patients in the non-OAB group (p<0.01). No statistical significance was determined between the groups in terms of gender, HDL, glucose, presence of hypertension, smoking, BMI, or BUN. The patients in OAB group were found to have more significant narrowing in the coronary arteries than the patients in non-OAB group. Covariance analysis was applied to eliminate the age difference between the two groups but the statistically significant difference persisted (p<0.001). A high OAB-V8 score was correlated with a high Gensini score. Multiple regression analysis demonstrated a correlation of the OAB score with CAD risk factors, and cholesterol and LDL as independent risk factors.

In conclusion, chronic ischemic bladder, which is one of the possible causes of the high incidence of OAB in older patients, and coronary artery disease occur as a result of the same ischemic events within the vasculature. The times of emergence of these two diseases are related to the diameters of the arteries and their tolerance to ischemia. In our study, the incidence of serious coronary artery disease was found to be higher in patients with OAB symptoms, so these patients should be consulted to a cardiologist.

Written by: Fatih Kilinc

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