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Nocturia is associated with an increased risk of coronary heart disease and death

By D.J. Lightner, A.E. Krambeck, D.J. Jacobson, M.E. Mcgree, S.J. Jacobsen, M.M. Lieber, V.L. Roger, C.J. Girman and J.L. St. Sauver.

BJU International, Volume 110, Issue 6, September 2012, Pages 848-853

Study Type – Prognosis (inception cohort)

Level of Evidence 1b

What's known on the subject? and What does the study add?

Nocturia has been associated with multiple chronic conditions, however, previous studies have been conducted only at a single time. We found that nocturia preceded the development CHD in young men. Moderate nocturia may be an early marker of CHD in young men.

OBJECTIVE
• To determine whether nocturia is associated with the development of diabetes mellitus, hypertension, coronary heart disease (CHD) and occurrence of death.

MATERIALS AND METHODS
• We studied data obtained from a retrospective cohort of randomly selected men, aged 40–79 years in 1990, from Olmsted County, MN, USA.
• Moderate nocturia was defined as waking to urinate ≥2 times per night.
• Men were followed every 2 years through repeated questionnaires and community medical records to assess development of diabetes mellitus and hypertension, and occurrence of death. CHD was ascertained through ongoing surveillance of heart disease in Olmsted County.
• Cox proportional hazard models were used to estimate associations between baseline nocturia and each of the outcomes.

RESULTS
• A total of 2447 men were followed for a median of 17.1 years (25th and 75th percentiles: 15.0, 17.4 years).
• Moderate nocturia was not significantly associated with the later development of diabetes mellitus or hypertension in this study.
• Younger men (<60 years of age) with moderate nocturia were more likely to develop CHD later in life than younger men without nocturia (hazard ratio [HR]: 1.68; 95% confidence interval [CI]: 1.13, 2.49). This association was no longer significant when adjusted for age, body mass index (BMI) and urological medications (HR: 1.36; 95% CI: 0.87, 2.12).
• Older men (≥60 years of age) with moderate nocturia were more likely to die than older men without moderate nocturia, even after adjusting for age, BMI, urological medications and CHD (HR: 1.48; 95% CI: 1.15, 1.91).

CONCLUSION
• Nocturia may be a marker for increased risk of CHD in younger men, and death in older men.