Women at high cardiovascular (CV) risk may benefit less from anticholinergics, new research findings suggest.

In a study, 230 postmenopausal women (aged 43-70 years) with pure urge urinary incontinence (UUI) initiated treatment with solifenacin 5 mg, propiverine 30 mg, fesoterodine 4 mg, darifenacin 7.5 mg, or tolterodine 4 mg (including extended release formulations) with medication switching at 8 weeks, if desired.  Investigators stratified patients by their Framingham risk score for developing cardiovascular disease within 10 years, with 40.9%, 20.8%, and 38.3% determined to be at low, intermediate, and high risk, respectively.

Before and after treatment, patients reported their UUI frequency and severity on the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and quality of life (QoL) on the Incontinence Quality of Life Questionnaire (I-QOL). At admission, both ICIQ-SF and I-QOL scores were significantly worse across all domains (activity limitations, psychosocial effects, social embarrassment, and total score) in the high Framingham CV risk group compared with the other groups.

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At 8 and 16 weeks after anticholinergic treatment, UUI severity and quality of life improved significantly more in the low- and intermediate-risk Framingham risk groups compared with the high-risk group, Ismail Selvi, MD, of Basaksehir Cam ve Sakura City Hospital in Istanbul, Turkey, reported in Urology. By week 16, median ICIQ-SF score had improved 100% and 100% in the low- and intermediate-risk groups, respectively, compared with 66.6% in the high-risk group. The low-risk risk group had the highest proportion of patients with daily dryness (65.6%), followed by the intermediate-risk group (57.4%), and high-risk group (24.1%), the team reported. Further, refractory overactive bladder developed in a significantly greater proportion of high-risk patients than low- and intermediate-risk patients (19.3% vs 0% and 8.5%, respectively) after trying at least 2 different anticholinergics.

Compared with the low- and intermediate-risk groups, the high-risk group, had significantly greater proportions of patients with hypertension and diabetes mellitus and higher total cholesterol levels, body mass index, and significantly lower levels of high-density lipoprotein. Metabolic syndrome or atherosclerosis-related chronic ischemia, which overlap with the Framingham risk score, may affect bladder function, they stated.

“Our findings show that more severe UUI and more impaired QoL scores are observed in high-risk patients with cardiovascular morbidity,” Dr Selvi’s team wrote. “Individualized treatment may be important in the high-risk group since they may benefit less from anticholinergic therapy and refractory OAB can be more common in this group.”


Selvi I, Baydilli N, Ihsan Arik A, Basar H. The effect of cardiovascular morbidity on clinical responsiveness to anticholinergics in postmenopausal women with urge urinary incontinence. Urology. 147:96-103. doi:10.1016/j.urology.2020.10.033