Johnstone Jeannette, Lusty Avril, Tohidi Mina, Whitehead Marlo, Tranmer Joan, Nickel J Curtis, Siemens D Robert
Department of Urology, Queen's University, Kingston, ON, Canada.
Division of Urology, The Ottawa Hospital, Ottawa, ON, Canada.
Can Urol Assoc J. 2021 Aug;15(8):240-246. doi: 10.5489/cuaj.7489.
Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms are highly prevalent in the aging male. Similarly, the prevalence of metabolic syndrome is increasing worldwide, with mounting evidence that these two common conditions share more than age as a predisposing factor. The objective of this study was to determine if medical management of BPH is associated with an increased risk of new-onset diabetes mellitus (DM) in routine care.
This population-based, retrospective cohort study expands on a parent study of linked administrative databases identifying patients diagnosed and treated for BPH between 2005 and 2015. The primary outcome of this secondary analysis was a new diagnosis of DM after the index date of BPH diagnosis. Covariates included age, dyslipidemia, hypertension, and vascular diseases. A Cox proportional hazards regression model was used for inferential statistical analysis.
A total 129 223 men were identified with a BPH diagnosis and no prior history of DM. Of those men, 6390 (5%) were exposed to 5-alpha-reductase inhibitor (5-ARI), 39 592 (31%) exposed to alpha-blocker (AB), and 30 545 (24%) exposed to combination therapy. Compared to those men with no BPH medication use, those exposed to drugs had an increased risk of new DM. Men treated with combination therapy of 5-ARI and AB (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.25-1.35), 5-ARI monotherapy (HR 1.25, 95% CI 1.17-1.34), or AB monotherapy (HR 1.17, 95% CI 1.13-1.22) all were at higher risk of new DM diagnosis after adjusting for important covariates. When calculating the risk of a new diabetes diagnosis measured from the start of drug exposure, men treated with 5-ARIs had an increased risk of DM compared to AB monotherapy as the reference, with HR 1.12 (95% CI 1.03-1.21) for 5-ARI monotherapy and HR 1.20 (95% CI 1.14-1.25) for combination therapy.
In this large, long-term, retrospective study of men with a BPH diagnosis in routine practice, the risk of a new diagnosis of DM was greater in patients receiving medical management compared to controls. This modest but significant increased risk was highest in men treated with any 5-ARIs, in combination as well as monotherapy, compared to the ABs.
良性前列腺增生（BPH）及相关下尿路症状在老年男性中极为常见。同样，代谢综合征在全球的患病率也在上升，越来越多的证据表明，这两种常见病症的共同诱发因素不止是年龄。本研究的目的是确定在常规治疗中，BPH的药物治疗是否会增加新发糖尿病（DM）的风险。
这项基于人群的回顾性队列研究是在一项关于关联行政数据库的母研究基础上展开的，该母研究识别了2005年至2015年间被诊断并接受治疗的BPH患者。本次二次分析的主要结局是在BPH诊断索引日期后新诊断出DM。协变量包括年龄、血脂异常、高血压和血管疾病。采用Cox比例风险回归模型进行推断性统计分析。
共识别出129223名被诊断为BPH且无DM既往史的男性。在这些男性中，6390名（5%）使用了5α还原酶抑制剂（5-ARI），39592名（31%）使用了α受体阻滞剂（AB），30545名（24%）接受了联合治疗。与未使用BPH药物的男性相比，使用药物的男性患新发DM的风险增加。在调整重要协变量后，接受5-ARI与AB联合治疗的男性（风险比[HR]1.30，95%置信区间[CI]1.25 - 1.35）、5-ARI单药治疗的男性（HR 1.25，95% CI 1.17 - 1.34）或AB单药治疗的男性（HR 1.17，95% CI 1.13 - 1.22）患新发DM诊断的风险均更高。当计算从开始药物暴露起新发糖尿病诊断的风险时，以AB单药治疗为参照，使用5-ARI治疗的男性患DM的风险增加，5-ARI单药治疗的HR为1.12（95% CI 1.03 - 1.21），联合治疗的HR为1.20（9５% CI 1.14 - 1.25）。
在这项针对常规临床实践中被诊断为BPH的男性的大型、长期回顾性研究中，与对照组相比，接受药物治疗的患者新发DM诊断的风险更高。与ABs相比，使用任何5-ARI进行联合或单药治疗的男性中，这种适度但显著增加的风险最高。
