Cardiovascular safety of 5α-reductase inhibitors in people with benign prostatic hyperplasia and type 2 diabetes: a propensity score-matched analysis
Main finding · MACE (SDRN-NDS)Result — go to the resultHazard ratio 1.15 95% CI 1.03–1.30Authors' conclusion
Our 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.
Study context
- Population
- Benign prostatic hyperplasia (BPH) patients ≥40 years with recorded type 2 diabetes mellitus and ≥2 prescriptions of 5α-reductase inhibitors or tamsulosin (2006–2021), SDRN-NDS and IMRD-UKpatients included per cohort · SDRN-NDS 11,969 · IMRD-UK 16,492
- Exposure
- 5α-reductase inhibitors in comparison with tamsulosin
- Outcome
- Major adverse cardiovascular events (MACE) (SDRN-NDS)
- Follow-up
- Median 3.8 (IQR: 1.7-6.8) years
Methodological details1:2 variable ratio propensity score matching, cause-specific Cox proportional-hazard models
- 1:2 variable ratio propensity score matching
- Cause-specific Cox proportional-hazard models
Main finding
As reported in the abstract
Hazard ratio
1.15
95% CI 1.03–1.30
P = 0.007
5α-reductase inhibitorsvs tamsulosin
HR 1.15 (95% CI 1.03–1.30); P = 0.007
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | P value | |
|---|---|---|---|
| Myocardial infarction (SDRN-NDS) | 1.20 (1.03–1.40) | P = 0.022 | |
| MACE (IMRD-UK) · median follow-up 4.8 (2.0-8.3) years | 1.26 (1.07–1.47) | P = 0.008 | |
| Myocardial infarction (IMRD-UK) | 1.33 (1.10–1.60) | P = 0.005 | |
| 0.512Hazard ratio (log scale) |
Stroke, cardiovascular death, microvascular complications of diabetes, progression to insulin-based therapies
- No increased risks observed
Original publication
Cardiovascular safety of 5α-reductase inhibitors in people with benign prostatic hyperplasia and type 2 diabetes: a propensity score-matched analysis. Eur Heart J Cardiovasc Pharmacother. Published 17 January 2026. doi:10.
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