5-alpha 還原酶抑制劑與心臟血管疾病的風險
謝登富、李祥生、林殿璜、劉昕和、蔡宗訓、陳至正
台中慈濟醫院泌尿科；花蓮慈濟大學醫院
5-alpha-reductase inhibitors and risk of cardiovascular diseases
Teng-Fu Hsieh , Shang-Sen Lee, Tien-Huang Lin, Hsin-Ho Liu, Tsung-Hsun Tsai, Chi-Cheng Chen
Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan；School of Medicine, Tzu Chi University, Hualian, Taiwan
Purpose: The aim of this study is to investigate the risk of cardiovascular diseases after 5-alpha-reductase inhibitor (5ARI) therapy for benign prostate hyperplasia (BPH) using the National Health Insurance Research Database (NHIRD) in Taiwan.
Materials and Methods: In total, 1,486 adult patients newly diagnosed with BPH and who used 5-alpha-reductase inhibitors were recruited as the study cohort, along with 9,995 subjects who did not use 5-alpha-reductase inhibitors as a comparison cohort. Each patient was monitored for 5 years, and those who subsequently had cardiovascular diseases were identified. A Cox proportional hazards model was used to compare the risk of cardiovascular diseases between the study and comparison cohorts after adjusting for possible confounding risk factors.
Results: The patients who received 5ARI therapy had a lower cumulative rate of cardiovascular diseases than those who did not receive 5ARI therapy during the 5-year follow-up period (8.4% vs. 11.2%, P=0.003). In subgroup analysis, the 5-year cardiovascular event hazard ratio (HR) was lower among the patients older than 65 years with 91 to 365 cumulative defined daily dose (cDDD) 5ARI use (HR=0.63, 95% confidence interval (CI) 0.42 to 0.92; P=0.018), however there was no difference among the patients with 28 to 90 and more than 365 cDDD 5ARI use (HR=1.14, 95% CI 0.77 to 1.68; P=0.518 and HR=0.83, 95% CI 0.57 to 1.20; P=0.310, respectively).
Conclusion: The present study indicated that 5ARI therapy was safe and did not increase the risk of cardiovascular events in the BPH patients in 5 years of follow-up. Further mechanistic research is needed.