Aterosklerozun Erken Dönemi ile Benign Prostat Hiperplazi Arasındaki İlişkinin Karotis İntima Media Kalınlığı Kullanılarak Değerlendirilmesi

Abstract

Giriş:  Bening prostat hiperplazisi (BPH), yaşlı erkeklerde en sık görülen hastalıktır. BPH’nin ateroskleroz ile ilişkisi bilinmesine karşın; subklinik ateroskleroz ile ilişkisi henüz değerlendirilmemiştir. Bizim çalışmamızın amacı, bu ilişkinin karotis intima media kalınlığı (KİMK) kullanılarak araştırılmasıydı.

Hastalar ve Yöntem: Çalışmaya, 50-65 yaş arasında 50 BPH hastası ve BPH’si olmayan 50 erkek hasta kontrol deneği dahil edildi. Alt ürüner sistem semptomları (AÜSS)’nın değerlendirilmesinde kullanılan, uluslararası prostat semptom skoruna (IPSS) göre,  hastalar hafif-orta AÜSS (IPSS < 20, n= 33 hasta) ve ciddi AÜSS (IPSS ≥ 20, n= 17 hasta) gruplarına ayrıldı. KİMK ve diğer parametreler açısından gruplar karşılaştırıldı.

Bulgular: Kontrol grubuyla karşılaştırıldığında, BPH grubunda KİMK önemli düzeyde yüksekti (sırasıyla, 0.73 ± 0.2 vs. 0.97 ± 0.3, p< 0.001). Ayrıca, yalnızca hastaları kapsayan alt grup analizinde, hafif-orta AÜSS grubuna göre ciddi AÜSS grubunda da CIMT önemli düzeyde yüksekti (sırasıyla, 0.84 ± 0.2 vs. 1.22 ± 0.3,     p< 0.001). KİMK ve IPSS arasında önemli derecede pozitif korelasyon vardı. Multivariate regresyon analizinde KİMK ve HDL kolesterol BPH’nin bağımsız göstergeleri olarak bulundu.

Sonuç: Subklinik ateroskleroz ve BPH aynı etiopatogenik faktörleri paylaşıyor olabilir. Bu nedenle benzer yaş grubundaki erkeklerde, BPH ve alt üriner sistem semptomları, aterosklerotik yükün göstergesi olabilir.

Keywords

• Benign prostat hiperplazisi,subclinical atherosclerosis,carotid intima-media thickness

Assessment of Relationship Between Subclinical Atherosclerosis and Benign Prostate Hyperplasia Using Epicardial Fat Thickness and Carotid Intima-Media Thickness

Abstract

Introduction: Benign prostatic hyperplasia (BPH) is the most common disorder in elderly men. Although the relationship between atherosclerosis and BPH is known, the association between subclinical atherosclerosis and BPH has not yet been investigated. The aim of our study was to assess this relationship using carotid intima-media thickness (CIMT).

Patients and Methods: Fifty patients with BPH and 50 control subjects without BPH of ages 50-65 years were enrolled. According to the international prostate symptom score (IPSS), which is used for the evaluation of LUTS, patients were divided into mild-moderate (IPSS< 20 point, n= 33 patients) and severe groups (IPSS ≥ 20 point, n= 17 patients). CIMT was evaluated using ultrasonography. The relationship between CIMT and other parameters were analysed.

Results: CIMT was significantly higher in BPH group (p= 0.02). In addition, it was significantly higher in severe LUTS group in subgroup analyses, which included only patients (1.22 ± 0.3 vs. 0.84 ± 0.2, p< 0.001). There was a positive correlation between CIMT and IPSS (r= 0.745, p< 0.001). CIMT and HDL cholesterol were found to be independent predictors of BPH in multivariate analysis.

Conclusion: Subclinical atherosclerosis and BPH may share common aetiopathogenic factors. Therefore, BPH and lower urinary tract symptoms may be indicators of atherosclerotic burden in men of the same age group.

Keywords

• Benign prostatic hyperplasia,subclinical atherosclerosis,carotid intima-media thickness

References

1. 1. Ghafar MA, Puchner PJ, Anastasiadis AG, Cabelin MA, Buttyan R. Does the prostatic vascular system contribute to the development of benign prostatic hyperplasia? Curr Urol Rep 2002;3:292-6.
2. 2. Parsons JK, Carter HB, Partin AW, Windham BG, Metter EJ, Ferrucci L, et al. Metabolic factors associated with benign prostatic hyperplasia. J Clin Endocrinol Metab 2006;91:2562-8.
3. 3. Parsons JK. Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol 2007;178:395-401.
4. 4. Thompson MM, Garland C, Barrett-Connor E, Khaw KT, Friedlander NJ, Wingard DL. Heart disease risk factors, diabetes and prostatic cancer in an adult community. Am J Epidemiol 1989;129:511-7.
5. 5. Berger AP, Bartsch G, Deibl M, Alber H, Pachinger O, Fritsche G, et al. Atherosclerosis as a risk factor for benign prostatic hyperplasia. BJU Int 2006;98:1038-42.
6. 6. Touboul PJ, Grobbee DE, den Ruijter H. Assessment of subclinical atherosclerosis by carotid intima media thickness: technical issues. Eur J Prev Cardiol 2012;19:18-24.
7. 7. Erkan H, Kırış G, Korkmaz L, Çavuşoğlu İG, Çelik Ş. Predictive value of nitrate-induced headache on atherosclerotic burden in patients with stable coronary artery disease. Kosuyolu Heart J 2016;19:12-6 Doi: 10.5578/khj.10343.
8. 8. Joint committee with the guidelines subcommittee of the Japan Academy of Neurosonology for ultrasonic assessment of carotid artery disease and the subcommittee for research into methods of screening atherosclerotic lesions. Guidelines for ultrasonic assessment of carotid artery disease: Preliminary report. Neurosonology 2002;15:20-33.

9. 9. Hammarsten J, Hoegstedt B. Hyperinsulinaemia as a risk factor for developing benign prostatic hyperplasia. Eur Urol 2001;39:151-8.
10. 10. Robert G, Descazeaud A, Nicolaïew N, Terry S, Sirab N, Vacherot F, et al. Inflammation in benign prostatic hyperplasia: a 282 patients’ immunohistochemical analysis. Prostate 2009;69:1774-80.
11. 11. Fibbi B, Penna G, Morelli A, Adorini L, Maggi M. Chronic inflammation in the pathogenesis of benign prostatic hyperplasia. Int J Androl 2010;33:475-88.
12. 12. Penna G, Mondaini N, Amuchastegui S, Degli Innocenti S, Carini M, Giubilei G, et al. Seminal plasma cytokines and chemokines in prostate inflammation: interleukin 8 as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome and benign prostatic hyperplasia. Eur Urol 2007;51:524-33.
13. 13. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr, et al. Carotid artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999;340:14-22.
14. 14. Mullen MJ, Thorne SA, Deanfield JE, Jones CJ. Non-invasive assessment of endothelial function. Heart 1997;77:297-8.
15. 15. Drexler H, Hornig B. Endothelial dysfunction in human disease. J Mol Cell Cardiol 1999;31:51-60.
16. 16. Bostan C, Coşkun U, Koçaş C, Karacop E, Abacı O, Kaya A, et al. Effects of trimetazidine treatment on the lipoprotein-associated phospholipase A2 level and exercise parameters in patients with stable angina pectoris. Kosuyolu Heart J 2015;18:126-9.
17. 17. Creager MA, Lüscher TF, Cosentino F, Beckman JA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation 2003;108:1527-32.
18. 18. McVary K. Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology. BJU Int 2006;2:23-8.
19. 19. Takeda M, Tang R, Shapiro E, Burnett AL, Lepor H. Effects of nitric oxide on human and canine prostates. Urology 1995;45:440-6.