Download Wuerstle 2011 - American Geriatrics Society

G4 Wuerstle MC, Van Den Eeden SK, Poon KT, et al. Contribution of common medications to lower urinary tract symptoms in men. Arch Intern Med 2011;171(18):1680-1682.
Results
Results (general)
Study
Population
Intervention Groups
Comments
Measure
Outcome
Wuerstle 2011
N = 63,579
n = risk not adjusted for BPH
Association between
OR (CI)
Older subjects displayed a
USA
medication use and LUTS
progressively greater proportion
Inclusion
Community
Antihistamines 1.11 (1.06 to 1.17)
of moderate to severe LUTS
Cross sectional
Men
Bronchodilators 1.22 (1.15 to 1.29)
California Men’s
Aged 45-69
Sympathomimetics 1.10 (1.01 to 1.20)
Asian Americans had a greater
Health Study (data
≥1 rx filled for included drug
Anticholinergics 0.96 (0.88 to 1.06)
prevalence of mild LUTS
from 2002 to 2003)
class
Diuretics 1.15 (1.10 to 1.21)
Antidepressants 1.39 (1.32 to 1.47)
African Americans had a greater
Purpose:
Exclusion
proportion of moderate to severe
To determine the
Surgery for enlarged prostate
Adjusted for age, race, region
LUTS
magnitude of the
Prostate cancer dx
and all medications
association between
Musculoskeletal conditions
simultaneously
Significant associations
medications and
Neurologic disorders
-medication use varied by
lower urinary tract
Bladder cancer
race/ethnicity (p <.001)
n = 14,215 risk adjusted for BPH
Association between
OR (CI)
symptoms (LUTS) in
Colon cancer
-medication use increased with
medication use and LUTS
men with and without
age (p <.001)
Antihistamines 1.09 (1.04 to 1.15)
benign prostatic
Bronchodilators 1.21 (1.14 to 1.29)
hyperplasia (BPH).
(include if appropriate)
In unadjusted analyses, every
Sympathomimetics 1.09 (1.00 to 1.20)
Data source
medication was associated with
Anticholinergics 0.94 (0.86 to 1.04)
LUTS
Diuretics 1.19 (1.13 to 1.24)
Methods
Antidepressants 1.36 (1.29 to 1.44)
Pharmacy records assessed
Strongest associations (adjusted)
for rx
-bronchodilators
Adjusted for age, race, region,
-antidepressants
-antidepressants
BPH and all medications
-antihistamines
simultaneously
-bronchodilators
Stratified for presence of BPH;
-nonurinary anticholinergics
strongest associations for men
n = risk stratified without BPH
Association between
OR (CI)
-sympathomimetics
without BPH(adjusted)
medication use and LUTS
-diuretics
-sympathomimetics
Antihistamines 1.07 (1.01 to 1.13)
-diuretics
Bronchodilators 1.21 (1.13 to 1.29)
Outcome
-antidepressants
Sympathomimetics 1.13 (1.02 to 1.25)
Anticholinergics 0.92 (0.83 to 1.03)
Follow up
Estimates accounting for LUTS
Diuretics 1.25 (1.19 to 1.31)
-antihistamines = 1%
Antidepressants 1.41 (1.33 to 1.50)
-bronchodilators = 2%
-diuretics = 3%
Adjusted for age, race, region
-antidepressants = 4%
and all medications
simultaneously
Use of any of these medications
could account for 10% of LUTS
n = 14,215 risk stratified with
Association between
OR (CI)
compared with 29% of symptoms
BPH
medication use and LUTS
associated with BPH
Antihistamines 1.17 (1.05 to 1.31)
Men and women (xx%)
Bronchodilators 1.21 (1.07 to 1.36)
Mean age xx (SD)
Sympathomimetics 0.96 (0.79 to 1.18)
Other
Anticholinergics 1.00 (0.83 to 1.21)
Diuretics 0.98 (0.90 to 1.08)
Antidepressants 1.21 (1.07 to 1.35)
Adjusted for age, race, region
and all medications
simultaneously
Conclusion: This study documents the association between specific categories of common medications and LUTS in a large, diverse population of community-dwelling men. If the observed
associations represent cause and effect relationships, these medications account for 10% of LUTS, an effect approximately one-third of that for BPH. This underscores the importance of assessing
medications in the differential diagnosis of LUTS.