Circadian Rhythms in Urology: Bridging Benign Prostatic Hyperplasia and Cardiovascular Disease Risk

To the Editor:

Suzuki et al.¹ pioneered the epidemiological study linking benign prostatic hyperplasia (BPH) and cardiovascular disease (CVD), analyzing health data from >2 million men to illustrate significant health risks associated with these conditions. Their research emphasizes the necessity for integrated urological and cardiovascular care, aimed at enhancing patient outcomes through comprehensive risk assessments and multidisciplinary management strategies.

Our study, published in the World Journal of Urology, delves deeper into this relationship by examining the intricate interactions between BPH, nocturia, and their systemic effects on metabolic and cardiovascular health, as illustrated in the Figure. We highlight how nocturia, commonly resulting from BPH, disrupts normal sleep patterns and circadian rhythms, which leads to reduced secretion of antidiuretic hormone (ADH) and decreased testosterone levels that not only exacerbate metabolic syndrome but also significantly elevate cardiovascular risks.²

Figure.

Interactions between low testosterone, metabolic syndrome, BPH/nocturia, and cardiovascular risks.

Further, Kato et al.³ demonstrate that nocturnal polyuria is closely linked with marked fluctuations in blood pressure over a 24-h period. Their findings underscore the profound implications of nocturnal voiding patterns on overall cardiovascular health, suggesting that effective management of nocturia could mitigate these risks.

Collectively, these studies advocate for a “uro-cardiology” framework that integrates cardiovascular and urological evaluations to optimize the clinical management of BPH patients. This approach not only aims to reduce cardiovascular complications, but also improve the overall quality of life for patients suffering from these chronic conditions.

Disclosures

The authors have no conflicts of interest to declare.

Acknowledgment

We acknowledge the assistance of OpenAI’s ChatGPT for manuscript refinement.

• Yu-Hsiang Lin, MD, PhD
• Po Ting Lin, MD
• Kuo Jen Lin, MD
• Department of Urology, Chang Gung Memorial Hospital & Chang Gung University, Taoyuan, Taiwan

References

• 1.   Suzuki Y, Kaneko H, Okada A, Fujiu K, Jo T, Takeda N, et al. Benign prostatic hyperplasia and incident cardiovascular disease. Circ J 2024; 88: 408–416.
• 2.   Lin YH, Wu CT, Juang HH. Exploring the complex interplay: BPH, nocturia, and aging male health. World J Urol 2024; 42: 105.
• 3.   Kato Y, Akaihata H, Takezawa K, Maekawa S, Matsuoka K, Fukuhara S, et al. Association between nocturnal polyuria and 24-h blood pressure fluctuations in males with lower urinary tract symptoms: A multicenter prospective study. Int J Urol 2024; 31: 259–264.