The Effect of Cardiovascular Morbidity on Clinical Responsiveness to Anticholinergics in Postmenopausal Women With Urge Urinary Incontinence

Published:November 04, 2020DOI:


      To evaluate whether there is an association between severity of cardiovascular morbidity and urge urinary incontinence (UUI), and to assess the clinical responses of postmenopausal female patients in different cardiovascular risk groups to anticholinergics.


      A total of 220 postmenopausal female patients aged 43-70 years old with overactive bladder with UUI between December 2019 and July 2020 were included. They were divided into 3 groups according to the Framingham risk score that calculates the 10-year risk of cardiovascular disease development: low-risk (n: 90, 40.9%), intermediate-risk (n: 47, 21.3%), and high-risk (n: 83, 37.8%).Their demographic and clinical data were recorded. The intensity of UUI and its effect on quality of life (QoL) were evaluated at admission, 8th week and 16th week of anticholinergic therapy.


      At admission attendance, BMI, smoking rate, presence of hypertension and diabetes mellitus, total cholesterol level and severity of UUI were higher in the high-risk group, whereas HDL level was lower and the effect of UUI on QoL was worse (P< .001). At the 16-week follow-up the improvement of UUI severity and QoL was significantly more pronounced in the low-risk and intermediate-risk groups (P< .001).The highest daily-dryness rates were observed in the low-risk group (65.6%), while the highest rates for refractory overactive bladder (OAB) were seen in the high-risk group (19.3%).


      Our findings show that more severe UUI and more impaired QoL is observed in high-risk patients for cardiovascular morbidity. Individualized treatment may be important in the high-risk group since they may benefit less from anticholinergics and refractory OAB can be more common.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Milsom I
        • Altman D
        • Cartwright R
        Epidemiology of urinary incontinence (UI) and other urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI).
        in: Abrams P Cardozo L Khoury S Wein AJ Incontinence. 5th ed. International Consultation on Urological Diseases and European Association of Urology, Paris2013: 17-107
      1. Gormley EA, Lightne DJ, Burgio KL, et al. AUA/SUFU guideline on non-neurogenic overactive bladder in adults. the 2014 Update. Accessed 1 June 2020.

      2. ICS Standards 2019. The 2019 compilation of the International Continence Society Standardisations, consensus statements, educational modules, terminology and fundamentals documents, with the international consultation on incontinence algorithms. Accessed 1 June 2020

      3. Burkhard FC, Bosch JLHR, Cruz F, et al. European Association of Urology guidelines on urinary incontinence: the 2020 update. In. ISBN 978-94-92671-04-2. EAU Guidelines Office, Arnhem, The Netherlands. Accessed 1 June 2020

        • Alberti KG
        • Zimmet P
        • Shaw J
        Metabolic syndrome – a new world-wide definition. A consensus statement from the International Diabetes Federation.
        Diabet Med. 2006; 23: 469-480
        • Link CL
        • Steers WD
        • Kusek JW
        • et al.
        The association of adiposity and overactive bladder appears to differ by gender: results from the Boston Area Community Health Survey.
        J Urol. 2011; 185: 955-963
        • Yeniel AO
        • Ergenoglu AM
        • Meseri R
        • et al.
        Is overactive bladder microvasculature disease a component of systemic atheroscleorosis?.
        Neurourol Urodyn. 2018; 37: 1372-1379
        • Bunn F
        • Kirby M
        • Pinkney E
        • et al.
        Is there a link between overactive bladder and the metabolic syndrome in women? A systematic review of observational studies.
        Int J Clin Pract. 2015; 69: 199-217
        • Novakovic ZS
        • Tesija RA
        • Puljak L
        Association between metabolic syndrome and overactive bladder: a case-control study.
        Scand J Urol. 2017; 51: 470-473
        • Cetinel B
        • Ozkan B
        • Can G
        The validation study of ICIQ-SF Turkish version.
        Turk J Urol. 2004; 30: 332-338
        • Eyigor S
        • Karapolat H
        • Akkoc Y
        • Yesil H
        • Ekmekci O
        Quality of life in patients with multiple sclerosis and urinary disorders: reliability and validity of Turkish-language version of Incontinence Quality of Life Scale.
        J Rehabil Res Dev. 2010; 47: 67-71
        • Villacampa F
        • Ruiz MA
        • Errando C
        • et al.
        Predicting self-perceived antimuscarinic therapy effectiveness on overactive bladder symptoms using the overactive bladder 8-question awareness tool.
        Int Urogynecol J. 2013; 24: 573-581
        • Jahangiry L
        • Farhangi MA
        • Rezaei F
        Framingham risk score for estimation of 10-years of cardiovascular diseases risk in patients with metabolic syndrome.
        J Health Popul Nutr. 2017; 36: 36
        • Kasman A
        • Stave C
        • Elliott CS
        Combination therapy in overactive bladder-untapped research opportunities: a systematic review of the literature.
        Neurourol Urodyn. 2019; 38: 2083-2092
        • Apostolidis A
        • Averbeck MA
        • Sahai A
        • Rahnama'i MS
        • Anding R
        • Robinson D
        Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015).
        Neurourol Urodyn. 2017; 36: 882-893
        • Phe V
        • de Wachter S
        • Roupret M
        • Chartier-Kastler E
        How to define a refractory idiopathic overactive bladder?.
        Neurourol Urodyn. 2015; 34: 2-11
        • Uzun H
        • OÜ Zorba
        Metabolic syndrome in female patients with overactive bladder.
        Urology. 2012; 79: 72-75
        • Lee WC
        • Chien CT
        • Yu HJ
        • et al.
        Bladder dysfunction in rats with metabolic syndrome induced by long term fructose feeding.
        J Urol. 2008; 179: 2470-2476
        • Schimit GTF
        • Gregorio EP
        • Averbeck MA
        • et al.
        Is there a link between carotid atherosclerosis and idiopathic overactive bladder among women with metabolic syndrome?.
        Res Rep Urol. 2020; 12: 43-48
        • Jackson RA
        • Vittinghoff E
        • Kanaya AM
        • et al.
        Urinary incontinence in elderly women: findings from the Health, Aging, and Body Composition Study.
        Obstet Gynecol. 2004; 104 (301-207.)
        • Gokkaya CS
        • Ozden C
        • Aktaş BK
        • et al.
        The correlation between metabolic syndrome and lower urinary tract symptoms in females.
        Turk J Med Sci. 2013; 43: 400-404
        • de Boer TA
        • Slieker-ten Hove MCP
        • Burger CW
        • Vierhout ME
        The prevalence and risk factors of overactive bladder symptoms and its relation to pelvic organ prolapse symptoms in a general female population.
        Int Urogynecol J. 2011; 22: 569-575
        • Tsui A
        • Kuh D
        • Cardozo L
        • Davis D
        Vascular risk factors for male and female urgency urinary incontinence at age 68 years from a British birth cohort study.
        BJU Int. 2018; 122: 118-125
        • Zacche MM
        • Giarenis I
        • Thiagamoorthy G
        • Robinson D
        • Cardozo L
        Is there an association between aspects of the metabolic syndrome and overactive bladder? A prospective cohort study in women with lower urinary tract symptoms.
        Eur J Obstet Gynecol Reprod Biol. 2017; 217: 1-5
        • Peyronnet B
        • Mironska E
        • Chapple C
        • Cardozo L
        • Oelke M
        • Dmochowski R
        A comprehensive review of overactive bladder pathophysiology: on the way to tailored treatment.
        Eur Urol. 2019; 75: 988-1000
        • Robinson D
        • Cardozo L.
        Estrogens and the lower urinary tract.
        Neurourol Urodyn. 2011; 30: 754-757