The Cardiovascular Safety of Five-Alpha-Reductase Inhibitors Among Men with Benign Prostatic Hyperplasia: A Population-Based Cohort Study - 20/09/23
Abstract |
Background |
Five-alpha reductase inhibitors (5αRIs) are used to treat benign prostatic hyperplasia (BPH). However, the cardiovascular effects of 5αRIs remain poorly understood. The study objective was to compare the rate of hospitalization for heart failure among men with BPH prescribed 5αRIs to that of men with BPH not prescribed BPH medications.
Methods |
Using the Clinical Practice Research Datalink linked with hospitalization and vital statistics data, we conducted a population-based cohort study among patients newly diagnosed with BPH. We defined exposure as the current use of 5αRIs, current use of alpha-blockers, and no current use of BPH medications in a time-varying approach. The primary endpoint was hospitalization for heart failure, and secondary endpoints were myocardial infarction, stroke, and cardiovascular death. We used time-dependent Cox-proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).
Results |
Our cohort included 94,440 men with incident BPH. A total of 3893 hospitalizations for heart failure occurred over 527,660 person-years of follow-up (incidence rate 7.38; 95% CI, 7.15-7.61, per 1000 person-years). Compared with no current use of BPH medications, current use of 5αRIs was not associated with an increased risk of hospitalization for heart failure (HR 0.94; 95% CI, 0.86-1.03), myocardial infarction (HR 0.92; 95% CI, 0.81-1.05), stroke (HR 0.94; 95% CI, 0.85-1.05), or cardiovascular death (HR 0.89; 95% CI, 0.80-0.99).
Conclusions |
The use of 5αRIs was not associated with an increased risk of hospitalization for heart failure, myocardial infarction, stroke, or cardiovascular death compared with non-use.
Le texte complet de cet article est disponible en PDF.Keywords : Alpha-blockers, Benign prostatic hyperplasia, Cardiovascular safety, Cohort study, Five-alpha reductase inhibitors, heart failure
Plan
| Funding: This study was funded by a Canadian Institutes of Health Research operating grant (MOP-136946). HTA was supported by a postdoctoral award from the Fonds de Recherche du Québec–Santé. HTA and KBF are supported by salary support awards from the Fonds de Recherche du Québec–Santé and William Dawson Scholar awards from McGill University. RWP is a member of the Research Institute of the McGill University Health Center, which receives financial support from the Fonds de Recherche du Québec–Santé, and holds the Albert Boehringer I endowed chair in Pharmacoepidemiology at McGill University. The sponsors had no role in designing, data analysis, manuscript preparation, and dissemination or publication of the study. |
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| Conflict of Interest: HTA is an employee of Merck. Finasteride, which is one of the 5-alpha reductase inhibitors and is sold under the brand name Proscar®, is manufactured by Merck. However, HTA conducted this study during his postdoctoral fellowship at McGill University prior to his employment at Merck. RWP reports personal fees from Biogen, Boehringer Ingelheim, Merck, Pfizer, and Analysis Group, outside the submitted work. LA reports consulting fees from Janssen and Pfizer for work unrelated to this study. The remaining authors have no relationships to disclose. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 136 - N° 10
P. 1000 - octobre 2023 Retour au numéro
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