Cardiac Failure Associated with Medical Therapy of Benign Prostatic Hyperplasia: A Population Based Study
Bibliographic record
Abstract
Purpose: Increased risk of cardiac failure with a-blockers in hypertension studies and 5-alpha reductase inhibitors in prostate studies have raised safety concerns for long term management of benign prostatic hyperplasia.The objective of this study was to determine if these medications are associated with an increased risk of cardiac failure in routine care. Materials and Methods:This population based study used administrative databases including all men over 66 with a diagnosis of benign prostatic hyperplasia between 2005 and 2015.Men were categorized based on 5-alpha reductase inhibitor exposure and/or a-blocker exposure with a primary outcome of new cardiac failure utilizing competing risk models.Explanatory variables examined included exposure thresholds, formulations, age, and comorbidities associated with cardiac disease.Results: The data set included 175,201 men with a benign prostatic hyperplasia diagnosis with 8,339, 55,383, and 41,491 exposed to 5-alpha reductase inhibitor, a-blocker and combination therapy, respectively.Men treated with 5-alpha reductase inhibitor and a-blocker, alone or in combination, had a statistically increased risk of being diagnosed with cardiac failure compared to no medication use.Cardiac failure risk was highest for a-blockers alone (HR 1.22; 95% CI 1.18e1.26),intermediate for combination a-blockers/5-alpha reductase inhibitors (HR 1.16; 95% CI 1.12e1.21)and lowest for 5-alpha reductase inhibitors alone (HR 1.09; 95% CI 1.02e1.17).Nonselective a-blocker had a higher risk of cardiac failure than selective a-blockers (HR 1.08; 95% CI 1.00e1.17).Conclusions: In routine care, men with a benign prostatic hyperplasia diagnosis and exposed to both 5-alpha reductase inhibitor and a-blocker therapy had an increased association with cardiac failure, with the highest risk for men exposed to nonselective a-blockers.Key Words: prostatic hyperplasia, heart failure, 5-alpha reductase inhibitors, adrenergic alpha-antagonists, lower urinary tract symptoms BENIGN prostatic hyperplasia and cardiovascular diseases are common conditions in the aging male.1,2 Mounting evidence suggests that a relationship between the two may be due to more than chance alone, potentially with shared pathophysiological processes.3,4 Although still unclear, proposed underlying mechanisms of this association include cigarette smoking, high blood pressure, and dyslipidemia.Other suggested causal factors include oxidative stress, vascular calcification, and metabolic syndrome.5 Chronic inflammation may also play a pivotal role in this link between BPH and cardiac Abbreviations and Acronyms
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".