CONTEXT: The correlation among metabolic syndrome, lower urinary tract symptoms 
(LUTS), and cardiovascular disease (CVD) is well established. In particular, CVD 
has been proposed as a potential risk factor for both LUTS progression and 
severity.
OBJECTIVE: To evaluate whether LUTS severity can be considered as a significant 
risk factor of major adverse cardiac events (MACE) in the male population.
EVIDENCE ACQUISITION: A systematic literature search was performed using PubMed, 
Google Scholar, and Scopus. The combination of the following keywords was 
adopted in a free-text strategy: benign prostatic hyperplasia (BPH) or lower 
urinary tract symptoms (LUTS) and cardiovascular, cardio, major adverse cardiac 
events, MACE, heart disease, heart, myocardial infarction, myocardial, 
infarction, stroke, ischemic events, ischemic, cardiac death, coronary syndrome. 
We included all cross-sectional and longitudinal trials enrolling men and 
comparing the prevalence or incidence of MACE in men with moderate to severe 
LUTS compared with those without LUTS or with mild LUTS. The studies in which 
only nocturia was evaluated were excluded from the analysis.
EVIDENCE SYNTHESIS: Of 477 retrieved articles, 5 trials longitudinally reported 
the incidence of MACE in patients with moderate to severe LUTS in comparisons to 
those with mild or no LUTS and 10 studies reported the prevalence of history of 
MACE at enrollment. All were included in the present meta-analysis. Among 
cross-sectional studies, 38 218 patients and 2527 MACE were included in the 
meta-analysis. The mean age of enrolled patients was 62.2±8.0 yr. Presence of 
moderate to severe LUTS significantly increased the risk of reported history of 
MACE (p<0.001). Metaregression analyses showed that the risk of MACE was lower 
in older patients and higher in those with diabetes. The association between 
LUTS-related MACE and diabetes was confirmed in a multivariate regression model 
after adjusting for age (adjusted r=0.498; p<0.0001). Longitudinal trials 
included 25 494 patients and 2291 MACE. The mean age of enrolled patients was 
52.5±5.5 yr, and mean follow-up was 86.8±22.1 mo. Presence of moderate to severe 
LUTS was associated with an increased incidence of MACE compared with the rest 
of the sample (odds ratio: 1.68; 95% confidence interval, 1.13-2.50; p=0.01).
CONCLUSIONS: Men with moderate to severe LUTS seem to have an increased risk of 
MACE. A holistic approach in considering the morbidities of aging men should be 
strongly encouraged and represents an important role for the practicing 
urologist.
PATIENT SUMMARY: We evaluated whether the severity of lower urinary tract 
symptoms could be considered as a significant risk factor for major adverse 
cardiac events (MACE) in the male population. We demonstrated that men with 
moderate to severe LUTS have an increased risk of MACE.