Better Cardiovascular Health Tied to Lower Overactive Bladder Risk

Adults with better overall cardiovascular health, as measured by Life's Essential 8 (LE8) score from the American Heart Association (AHA), have significantly lower odds of overactive bladder (OAB) and its related symptoms, according to a new cross-sectional analysis of national survey data published in Annals of Medicine & Surgery.¹ The findings, drawn from more than 6000 US adults, suggest that body mass index (BMI) and sleep health, which are modifiable components of cardiovascular health, are the strongest drivers of the association, adding urological function to the growing list of outcomes tied to cardiometabolic risk.

“Established risk factors for OAB include age, sex, and comorbidities such as diabetes,” the authors explained. “However, growing evidence suggests that broader cardiometabolic and lifestyle factors may also influence urological health.”

The study used data from the National Health and Nutrition Examination Survey (NHANES) collected between 2005 and 2020. Researchers categorized participants' cardiovascular health as low, moderate, or high based on their LE8 score, a composite metric that combines 4 health behaviors (diet, physical activity, nicotine exposure, and sleep) with 4 health factors (BMI, blood lipids, blood glucose, and blood pressure). After adjusting for demographic and clinical covariates, participants with high cardiovascular health had 41% lower odds of OAB than those with low cardiovascular health (OR, 0.59; 95% CI, 0.38-0.91), and each 10-point increase in LE8 score was associated with a 13% reduction in OAB odds (OR, 0.87; 95% CI, 0.80-0.95).

BMI, Sleep, and Inflammation Linking Heart Health to Overactive Bladder

The relationship was not a straight line. Restricted cubic spline modeling identified a nonlinear, threshold-based pattern: risk fell steadily as LE8 scores rose, then plateaued around a score of 73. Below that threshold, urgency urinary incontinence and nocturia scores dropped sharply with each additional gain in cardiovascular health; above it, further improvement yielded diminishing returns. The authors suggested patients whose LE8 scores fall below 73 may stand to benefit most from cardiometabolic interventions aimed at reducing OAB burden.

When researchers broke the LE8 score into its 8 components, BMI was the largest contributor to every OAB-related outcome measured, accounting for 27% to 43% of the explained association depending on the specific symptom. Sleep health was the second-largest contributor, particularly for OAB overall and nocturia. Diet is often considered a cornerstone of cardiovascular health but did not emerge as a top independent contributor, which the study authors said may reflect diet's more indirect influence through its effects on weight and glucose control.

Mediation analysis offered a partial biological explanation. Systemic inflammation, measured via a validated immune-inflammation index, accounted for 4.8% of the total association between LE8 score and OAB, while plasma osmolality—a marker of fluid and electrolyte balance—accounted for 12.8%. Because a substantial direct effect remained even after accounting for both mediators, the authors noted that other unmeasured pathways, such as autonomic nervous system function, are likely also involved.

Where OAB Care Still Falls Short of Guideline Intent

Urology groups are already rethinking how OAB is diagnosed and treated. The 2024 American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guideline update formally recognized nonurological contributors, including obesity, as relevant to OAB management and eliminated mandatory step therapy in favor of shared decision-making.² However, payer prior authorization requirements have not consistently aligned with the new guideline, and general urologists are less likely than pelvic medicine subspecialists to provide patients with third-line therapies such as sacral neuromodulation or onabotulinumtoxinA.^3,4

An analysis of Medicare beneficiaries found that among those who received minimally invasive OAB therapy, just 34.5% continued treatment over 2 years, with continuation rates varying widely by modality.⁵

OAB can carry a substantial and often underappreciated economic weight, with total US costs estimated in the billions of dollars annually and documented effects on workplace productivity.^6,7 A separate 2026 analysis using the same NHANES cohort structure found that OAB is also strongly associated with suicidal ideation, an association driven primarily by depression rather than urinary symptoms alone, underscoring the condition's reach beyond bladder function.⁸

What the Study Can’t Prove

The study authors were candid about several constraints on how far the findings can be extended. Because the data are cross-sectional, the analysis cannot establish that improving cardiovascular health reduces OAB risk, only that the 2 are statistically linked. Reverse causation and residual confounding from unmeasured factors such as detailed neurological history, pelvic floor anatomy, or genetic predisposition cannot be ruled out. OAB status was determined using a validated symptom questionnaire rather than a formal urological diagnosis, which could introduce some misclassification, although the risk was limited. Finally, the selected subset of the original NHANES population may limit how broadly the results generalize, and the large number of subgroup comparisons run elevates the risk of chance findings.

Despite those caveats, the authors framed the overall pattern as a reasonably firm basis for action. They concluded that ideal cardiovascular health, as captured by a high LE8 score, is consistently and inversely tied to both the presence and severity of OAB, with the relationship following a nonlinear, threshold-based course and running partly through inflammatory and osmotic pathways.

“Prioritizing improvements in BMI and sleep health represents a potentially cost-effective strategy for preventing or ameliorating OAB symptoms, as these factors are modifiable through lifestyle interventions and have well-established cardiovascular benefits,” the authors concluded.

References

1. Yan M, Jiang X. A retrospective cross-sectional study on the nonlinear association between cardiovascular health and overactive bladder in a national population-based cohort. Ann Med Surg (Lond). 2026;88(9):4922-4932. doi:10.1097/MS9.0000000000004983
2. Cameron AP, Chung DE, Dielubanza EJ, et al. The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. J Urol. 2024;212(1):11-20. doi:10.1097/JU.0000000000003985
3. Fosnight A. From guideline to practice: bridging the 3 gaps in OAB. Urology Times^®. June 24, 2026. Accessed August 28, 2026. https://www.urologytimes.com/view/from-guideline-to-practice-bridging-the-3-gaps-in-oab
4. Schieszer J. General urologists less likely to utilize third-line OAB treatments. Urology Times. February 28, 2018. Accessed August 28, 2026. https://www.urologytimes.com/view/general-urologists-less-likely-utilize-third-line-oab-treatments
5. Nseyo U. Retrospective study suggests differences in OAB therapy persistence among older adults. Urology Times. June 20, 2026. Accessed August 28, 2026. https://www.urologytimes.com/view/retrospective-study-suggests-differences-in-oab-therapy-persistence-among-older-adults
6. Onukwugha E, Zuckerman IH, McNally D, Coyne KS, Vats V, Mullins CD. The total economic burden of overactive bladder in the United States: a disease-specific approach. Am J Manag Care. 2009;15(4 suppl):S90-7.
7. Sexton CC, Coyne KS, Vats V, Kopp ZS, Irwin DE, Wagner TH. Impact of overactive bladder on work productivity in the United States: results from EpiLUTS. Am J Manag Care. 2009 Mar;15(4 suppl):S98-S107
8. Su Y, Yuan H, He J, Pan H, Luo L. Overactive bladder and suicidal ideation: a national cross-sectional study identifying depression as the primary mediator. Neurourol Urodyn. 2026;45(6):1168-1178. doi:10.1002/nau.70324