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Alpha blockers (AB), 5-alpha reductase inhibitors (5-ARI) and combination therapy are widely prescribed for lower urinary tract symptoms (LUTS) considered consequent to prostatic enlargement and are the mainstay of first-line therapy. This retrospective interrogation of a large population-based dataset of 175,201 men concluded that there is statistically significant increased incidence of new cardiac failure exposed to the above medication compared to those not exposed to medication, after consideration of age and other covariates associated with cardiovascular disease. The hazards ratios for risk of cardiac failure for men on AB, combination therapy and 5-ARIs were 1.22 (95% CI 1.05-1.23), 1.16 and 1.09, with the risk being higher for men on non-selective alpha blockers compared to non-selective ones. This study adds to the increasing body of evidence of side-effects of medical therapy for male LUTS. Most men were given AB monotherapy to avoid side-effects of 5-ARIs (decreased libido, erectile and ejaculatory dysfunction, fatigue, etc.) but this was the group most associated with newly diagnosed cardiac failure. With the evolution of surgical innovation and availability of several new options, will this hasten the advocacy of early surgical intervention? What is a safe duration of treatment? At the very least, patients and prescribing physicians should be made aware of this during conversations on treatment choices.

Cardiac failure associated with medical therapy of benign prostatic hyperplasia: a population based study.
Lusty A, Siemens DR, Tohidi M, et al.
2021;205(5): 1430-7.
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Jay Khastgir

Princess of Wales Hospital, Bridgend & Swansea University School of Medicine.

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