Medicines for benign prostatic hyperplasia, that are related to an elevated danger of coronary heart failure
Widely used drugs for benign prostatic hyperplasia (BPH) – also known as enlarged prostate – may be linked to a small but significant increase in the likelihood of heart failure, suggests a study in the Journal of Urology®, Official Journal of the American Urological Association ( AUA). The magazine is published by Wolters Kluwer in the Lippincott portfolio.
The risk is highest in men who take a type of BPH drug called alpha blockers (ABs) rather than another type of 5-alpha reductase inhibitors (5-ARIs). This is based on the new research by Dr. Robert Siemens, MD. and colleagues from Queen’s University, Kingston, Ontario, Canada. “While no one should stop taking their BPH medication based on these results, our study provides new insights into understanding the complex interaction of factors that influence heart disease risk in men with BPH,” commented Dr. Siemens.
Do BPH Drugs Affect Your Risk Of Heart Failure? New long-term follow-up data
Benign prostatic hyperplasia is a very common condition in men, especially in old age. It occurs when the prostate becomes enlarged and causes urinary discomfort (such as frequent and difficult urination). Millions of men take drugs to relieve symptoms of BPH – most commonly ABs, 5-ARIs, or a combination of both.
Both BPH and cardiovascular disease are common in older men, which may reflect common risk factors or causes. Clinical studies have shown that men who take ABs or 5-ARIs are more likely to develop heart failure: a chronic condition in which the heart cannot pump enough blood to keep up with demand. However, other studies have not found such a link.
To clarify the link between BPH drugs and heart failure, Dr. Siemens and colleagues health data from Ontario to identify more than 175,000 men diagnosed with BPH. Approximately 55,000 patients were treated with ABs alone, 8,000 with 5-ARIs alone, and 41,000 with a combination of ABs and 5-ARIs. The rest were not taking either type of BPH medication.
When analyzing the follow-up data, men treated with ABs and / or 5-ARIs were more likely to be diagnosed with heart failure. The risk of developing heart failure was 22 percent in men who took ABs alone, 16 percent in men who took combination therapy, and 9 percent in men who took 5 ARIs only, compared to the control group of men not taking BPH medication. The associations were significant after adjusting for other characteristics, including risk factors for heart disease.
The risk of heart failure was higher in older “nonselective” ABs than in newer “selective” ABs. The risk was higher in men who took ABs for a long time: 14 months or more.
Dr. Siemens and co-authors emphasize that the increased likelihood of developing heart failure was statistically high, but the absolute risk was relatively low. Risk factors such as previous heart disease, high blood pressure, and diabetes had a much greater impact on heart failure risk compared to BPH drugs. The researchers also note that the control group of patients who did not take 5-ARIs or ABs may have less severe symptoms of BPH, with possible differences in risk factors for heart disease.
Our study suggests that men who take ABs and / or 5-ARIs are more likely to be diagnosed with heart failure. This is an important finding because BPH is so common in older men and these drugs are so widely used. “
Dr. Robert Siemens, MD, Queen’s University, Kingston, Ontario, Canada
Dr. Siemens adds, “Because men with BPH may take these drugs for several years, it is important that doctors, including general practitioners and urologists, be aware of this risk, possibly particularly in those with previous heart disease or cardiovascular risk factors.”
Lusty, A. et al. (2021) Heart Failure Associated with Medical Therapy for Benign Prostatic Hyperplasia: A Population-Based Study. Journal of Urology. doi.org/10.1097/JU.0000000000001561.