Hyperlipidemia as a risk factor for discontinuation of prescribed antimuscarinics among geriatric overactive bladder patients

Abstract

Dear Editor Although antimuscarinic drugs have been the gold standard for the treatment of overactive bladder (OAB) for many years, high discontinuation rates have been noted. Previous studies reported an association between comorbidity and the persistence of antimuscarinic agents in OAB patients. For example, Lua et al. reported that the OAB patients with concurrent diabetes mellitus, hypertension, or depression are more likely to persist with anticholinergic medications. However, the association between comorbidity and medication persistence in OAB patients treated with antimuscarinics may not only be positive, but may also be negative. Therefore, identifying comorbidities associated with low persistence is a topic of great interest because a short-period prescription and close outpatient follow-up are recommended in these patients. Although Yu et al. reported no significant association between comorbidity and persistence with antimuscarinics, Balkrishnan et al. identified lower persistence with antimuscarinics among those with comorbidities. However, both these studies used the Charlson Comorbidity Index to rate the severity of comorbidities instead of investigating the comorbidities themselves. Recently, Vouri et al. explored this issue in a contemporary population of older adults in the US and found that cancer, dry eyes, and urinary retention were comorbidities significantly associated with a lower persistence with antimuscarinics, whereas other comorbidities common among geriatric patients (eg, diabetes, hypertension, congestive heart failure, dementia or mild cognitive impairment, depression, and osteoporosis) were significantly associated with less discontinuation of antimuscarinics. Although that study was restricted to an older adult population, the results made us focus on each comorbidity independently. In our 10-year nationwide population-based cohort study in Taiwan, up to 52.6% of OAB patients using antimuscarinics for at least 3 months had concurrent hyperlipidemia, and hyperlipidemia has