Hsieh Teng-Fu, Yang Yu-Wan, Lee Shang-Sen, Lin Tien-Huang, Liu Hsin-Ho, Tsai Tsung-Hsun, Chen Chi-Cheng, Huang Yung-Sung, Lee Ching-Chih
Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Medicine, Tzu Chi University, Hualian, Taiwan.
Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
PLoS One. 2015 Mar 24;10(3):e0119694. doi: 10.1371/journal.pone.0119694. eCollection 2015.
This nationwide population-based study investigated the risk of cardiovascular diseases after 5-alpha-reductase inhibitor therapy for benign prostate hyperplasia (BPH) using the National Health Insurance Research Database (NHIRD) in Taiwan.
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 from 2003 to 2008. 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.
The patients who received 5-alpha-reductase inhibitor therapy had a lower cumulative rate of cardiovascular diseases than those who did not receive 5-alpha-reductase inhibitor 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) 5-alpha-reductase inhibitor 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 5-alpha-reductase inhibitor 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).
5-alpha-reductase inhibitor therapy did not increase the risk of cardiovascular events in the BPH patients in 5 years of follow-up. Further mechanistic research is needed.
本项基于全国人口的研究利用台湾地区国民健康保险研究数据库（NHIRD），调查了5-α还原酶抑制剂治疗良性前列腺增生（BPH）后发生心血管疾病的风险。
2003年至2008年期间，共招募了1486例新诊断为BPH且使用5-α还原酶抑制剂的成年患者作为研究队列，同时选取9995例未使用5-α还原酶抑制剂的受试者作为对照队列。对每位患者进行5年的监测，并确定随后发生心血管疾病的患者。在调整可能的混杂风险因素后，使用Cox比例风险模型比较研究队列和对照队列之间心血管疾病的风险。
在5年随访期内，接受5-α还原酶抑制剂治疗的患者心血管疾病累积发生率低于未接受5-α还原酶抑制剂治疗的患者（8.4%对11.2%，P = 0.003）。亚组分析中，年龄大于65岁且5-α还原酶抑制剂累积限定日剂量（cDDD）为91至365的患者5年心血管事件风险比（HR）较低（HR = 0.63，95%置信区间（CI）0.42至0.92；P = 0.018），然而，5-α还原酶抑制剂cDDD为28至90以及大于365的患者之间无差异（HR分别为1.14，95%CI 0.77至1.68；P = 0.518和HR = 0.83，95%CI 0.57至1.20；P = 0.310）。
在5年随访期内，5-α还原酶抑制剂治疗未增加BPH患者发生心血管事件的风险。需要进一步开展机制研究。
