ArticleEuropean heart journal. Cardiovascular pharmacotherapy2026
Cardiovascular safety of 5α-reductase inhibitors in people with benign prostatic hyperplasia and type 2 diabetes: a propensity score-matched analysis.
Article in European heart journal. Cardiovascular pharmacotherapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Absence of Interaction Between 5α-Reductase Inhibitors and Glucocorticoids on Incidence of Myocardial Infarction in People With Type 2 Diabetes.Diabetes, obesity & metabolism · 2026Article
- Reframing Benign Prostatic Hyperplasia as a Cardiometabolic Condition: Should BPH Be Considered a Metabolic Disease?Reviews in cardiovascular medicine · 2026Article
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8 authors.
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Abstract
aims5α-Reductase inhibitors are prescribed for the treatment of benign prostatic hyperplasia (BPH) and their use is associated with increased risk of incident type 2 diabetes. This study assessed the long-term cardiovascular safety of 5α-reductase inhibitors in comparison with tamsulosin in people with co-existing BPH and type 2 diabetes. METHODS AND
resultsWe performed a retrospective, population-based cohort study using Scottish Diabetes Research Network National Diabetes Dataset (SDRN-NDS) and IQVIA Medical Research Data (IMRD-UK). BPH patients ≥40 years with recorded type 2 diabetes mellitus and ≥2 prescriptions of 5α-reductase inhibitors or tamsulosin (2006-2021) were included. After 1:2 variable ratio propensity score matching, cause-specific Cox proportional-hazard models were used to compute the hazard ratio (HR) of incident major adverse cardiovascular events (MACE). A total of 11 969 patients were included in SDRN-NDS and 16 492 in IMRD-UK, with median follow-up durations of 3.8 (IQR: 1.7-6.8) and 4.8 (2.0-8.3) years, 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, P = 0.007), driven by increased risk of myocardial infarction (MI) (HR 1.20, 1.03-1.40, P = 0.022). This was replicated in IMRD-UK, where HR was 1.26 (1.07-1.47, P = 0.008) for MACE and 1.33 (1.10-1.60, P = 0.005) for MI. We did not observe any increased risks in stroke, cardiovascular death, microvascular complications of diabetes, or faster progression to insulin-based therapies.
conclusionOur retrospective data from two large cohorts suggest that the risk of MACE may be increased among patients with type 2 diabetes taking 5α-reductase inhibitors, potentially driven by increased risk of MI. This supports careful monitoring of macrovascular outcomes when prescribing 5α-reductase inhibitors in this population.
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