Increased Risk of Recurrent Ischemic Stroke in Male Patients Taking Medications for Benign Prostatic Hyperplasia

TL;DR

Men with prostate issues taking certain medications face a higher risk of another stroke.

Contribution

This study identifies a novel link between BPH medications and increased risk of recurrent ischemic stroke in men.

Findings

BPH is associated with a 1.5-fold increased risk of recurrent ischemic stroke.

Alpha-1 blockers increase the risk of recurrent stroke with an adjusted HR of 1.581.

Long-term high-dose 5-alpha reductase inhibitors also raise stroke recurrence risk.

Abstract

Background: Patients with benign prostatic hyperplasia (BPH) have an increased risk of developing cardiovascular disease. Taking alpha-1 blockers is associated with an increased risk of major adverse cardiovascular events. Patients suffering from ischemic stroke (IS) may develop baroreflex and parasympathetic dysfunction-induced cerebral autoregulation impairment. The relationship between pharmacotherapy for BPH and the risk of recurrent IS remains unclear. The purpose of this study was to determine whether medications for BPH increase the risk of recurrent IS. Methods: This is a retrospective cohort study. Data from patients diagnosed with IS between 2000 and 2015 was collected from Taiwan National Health Insurance Database. Newly diagnosed IS patients were identified (International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM): 433–437). BPH patients with an ICD-9-CM of 600 were identified. The event observed was recurrent IS after the firstever IS. The factors associated with recurrent IS were assessed via Cox proportional hazards regression. Results: Recurrent IS was associated with BPH with an adjusted hazard ratio (HR) of 1.505 and a 95% confidence interval (CI) of 1.112–1.829, p < 0.001), and a competing risk model showed an adjusted HR of 1.544 (95% CI: 1.128–1.896, p < 0.001). The adjusted HR for treatment with alpha-1 blockers was 1.581 (95% CI: 1.16–1.915, p < 0.001), and increased risk with adjusted HR for treatment with high doses of 5-alpha reductase inhibitors over a long period of time are also at risk of recurrent IS. Conclusions: These findings highlight the association between BPH incidence and the risk of recurrent IS. The pharmacotherapy for BPH in IS patients should take great care.

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