1428 GREATER ENDOTHELIAL DYSFUNCTION AND ARTERIAL STIFFNESS IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME-A POSSIBLE LINK TO CARDIOVASCULAR DISEASE

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20111428 GREATER ENDOTHELIAL DYSFUNCTION AND ARTERIAL STIFFNESS IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME-A POSSIBLE LINK TO CARDIOVASCULAR DISEASE Daniel Shoskes, Dona Prots, Jeffrey Karns, Aaron Shoskes, and Joi Horhn Daniel ShoskesDaniel Shoskes Cleveland, OH More articles by this author , Dona ProtsDona Prots Cleveland, OH More articles by this author , Jeffrey KarnsJeffrey Karns Cleveland, OH More articles by this author , Aaron ShoskesAaron Shoskes Cleveland, OH More articles by this author , and Joi HorhnJoi Horhn Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1340AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have a significantly higher rate of self reported cardiac disease than controls but no mechanism for an association is known. Endothelial dysfunction and peripheral arterial stiffness correlate with cardiac disease and mortality. We wished to study these markers of vascular dysfunction in men with CP/CPPS compared to asymptomatic controls. METHODS Twenty one men with symptomatic, untreated CP/CPPS and 14 asymptomatic controls were tested with an Endo-PAT machine (Itamar Medical, Israel) that assessed the Augmentation Index(AI), a measure of arterial stiffness and Reactive Hyperemia Index (RHI), a measure of nitric oxide mediated endothelial vasodilation. Both elevated AI and diminished RHI suggest vascular and endothelial disease. Symptom severity in patients was measured by the NIH Chronic Prostatitis Symptom Index (CPSI) and patient phenotype characterized by the UPOINT system. All values except symptom duration met the D'Agostino test for normality and therefore parametric statistics were used with significance set at p<0.05. RESULTS Ages were similar in the CP/CPPS group (22–63 years, median 40) and controls (19–57, median 40). Patients had median symptom duration of 24 months (range 3–440), mean CPSI scores of 24.7+/−5.1 (range 18–37) and mean UPOINT domains of 2.9+/−1.1 (range 1–5). AI was significantly higher (greater arterial stiffness) in CPPS patients vs controls (5.0% +/−2.3 vs. −6.0%+/−3.0, p=0.006). RHI was significantly lower (more endothelial dysfunction) in CPPS patients (1.76+/−1.2 vs 2.21+/−1.7, p=0.03). Age had a negative correlation to RHI (Spearman R −0.48, p=0.03) but not AI. There was no correlation between symptom duration, severity or phenotype (number or type of UPOINT domains) and RHI or AI. CONCLUSIONS Men with CP/CPPS have evidence for increased arterial stiffness and vascular endothelial dysfunction. This is the first mechanistic correlation found to explain the higher incidence of self reported cardiac disease in these patients. Plausible mechanisms include chronic pain affecting vascular function and chronic stress and catecholamine release predisposing both to vascular changes and CP/CPPS. Noninvasive Endo-PAT testing may allow stratification of CP/CPPS patients by vascular dysfunction, which may require specific treatment, or at least further assessment of cardiac risk. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e572 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Shoskes Cleveland, OH More articles by this author Dona Prots Cleveland, OH More articles by this author Jeffrey Karns Cleveland, OH More articles by this author Aaron Shoskes Cleveland, OH More articles by this author Joi Horhn Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...