Use of 5[alpha]-reductase inhibitors and risk of major adverse cardiovascular diseases in people with benign prostatic hyperplasia and type 2 diabetes: a cohort study of two uk databases

Haolan Tu; Chengsheng Ju; Ewan Pearson; Li Wei; Ruth Andrew

doi:10.1530/endoabs.109.OP4.1

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Endocrine Abstracts (2025) 109 OP4.1 | DOI: 10.1530/endoabs.109.OP4.1

SFEBES2025 Poster Oral Presentations Thyroid and Reproduction (4 abstracts)

Use of 5α-reductase inhibitors and risk of major adverse cardiovascular diseases in people with benign prostatic hyperplasia and type 2 diabetes: a cohort study of two uk databases

Haolan Tu ¹ , Chengsheng Ju ² , Ewan Pearson ^3,4 , Li Wei ² & Ruth Andrew ¹

Author affiliations

¹University of Edinburgh, Edinburgh, United Kingdom. ²University College London, London, United Kingdom. ³University of Dundee, Dundee, United Kingdom. ⁴on behalf of Scottish Diabetes Research Network Epidemiology Group, Edinburgh, United Kingdom

Introduction: 5α-Reductase inhibitors are used in the long-term treatment of benign prostatic hyperplasia (BPH) to reduce androgen-dependent prostate growth. Their use has been associated with increased risk for type 2 diabetes mellitus. This study aimed to assess the cardiometabolic effects of 5α-reductase inhibitors in comparison with tamsulosin in patients with coexisting BPH and type 2 diabetes.

Methods: This study included all patients with BPH and type 2 diabetes receiving ≥2 prescriptions of 5α-reductase inhibitors or tamsulosin (control) in Scottish Diabetes Research Network National Diabetes Dataset (SDRN-NDS) and IQVIA Medical Research Data (IMRD-UK) between 2006-2021. Cardiometabolic outcomes included composite major adverse cardiovascular events (MACE), defined as myocardial infarction (MI), stroke, and cardiovascular death in SDRN-NDS, and MI and stroke in IMRD-UK; peripheral vascular diseases, diabetic retinopathy, nephropathy, neuropathy, and receipt of insulin-based medications. Hazard ratios (HR) were computed using the Cox proportional-hazard model after propensity score matching conditioned on baseline covariates.

Results: A total of 14,687 patients were included in SDRN-NDS and 17,289 in IMRD-UK with median follow-up durations of 3.8 years (IQR: 1.7-6.8) and 4.8 years (2.0-8.3), respectively. In SDRN-NDS, the HR of MACE in patients receiving 5α-reductase inhibitors relative to tamsulosin was 1.15 (95% CI 1.03-1.30), primarily driven by MI (1.20, 1.03-1.40). This was replicated in IMRD-UK, where the HR was 1.26 (1.07-1.47) for MACE and 1.33 (1.10-1.60) for MI. A moderate increase in risk compared to tamsulosin was found for peripheral vascular diseases (HR 1.20, 1.00-1.43). We did not observe any increased risk in stroke, other microvascular endpoints, or faster progression to insulin.

Conclusions: Among patients with co-existing BPH and type 2 diabetes, the risk of MACE is increased in users of 5α-reductase inhibitors, primarily driven by increased risk of MI. This suggests the need for careful monitoring of macrovascular outcomes when prescribing 5α-reductase inhibitors in this population.