Hyperlipidemia patients with long-term statin treatment are associated with a reduced risk of progression of benign prostatic enlargement

National prevalence and incidence of benign prostatic hyperplasia/lower urinary tract symptoms and validated risk factors pattern

BACKGROUND

To date, limited research has been conducted within China to elucidate the national prevalence and incidence rates of benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS). Additionally, there is a scarcity of studies that have systematically investigated the reliable risk factor patterns associated with the development of BPH/LUTS among the Chinese population.

METHODS

The study was in both cross-sectional and prospective cohort study design. The participants were derived from the China Health and Retirement Longitudinal Study (CHARLS). National prevalence and incidence of BPH/LUTS, average onset age of BPH/LUTS, medication rate of BPH/LUTS, and validated risk factors pattern of BPH/LUTS in the Chinese population were investigated.

RESULTS

The overall prevalence and annual incidence of BPH/LUTS were 11.10% and 2.23%. In China, the male population affected by BPH/LUTS typically presented at an average age of 55-65 years. However, the medication rate was merely more than 30%. After conducting univariate and multivariate logistic regression analysis in both cross-sectional and prospective cohort study designs, we observed that dyslipidemia was the most stable risk factor of BPH/LUTS occurrence in three adjusted models (OR [95% CI]: 2.41 [1.37-4.25]; 2.05 [1.10-3.81] and 2.40 [1.19-4.84], respectively).

CONCLUSIONS

This is the first study to delineate the prevalence and incidence of BPH/LUTS in Chinese, at the national level. The study reminded us that it was dyslipidemia rather than other chronic diseases or bad habits that posed a detrimental influence on BPH/LUTS occurrence in Chinese. Our data would facilitate the disease's early screening and medical policy formulation.

Association between chronic prostatitis and the subsequent benign prostatic hyperplasia: a population-based national cohort study

PURPOSE

To explore the association between chronic prostatitis (CP) and the subsequent development of benign prostatic hyperplasia (BPH).

METHODS

Data analyzed were medical claims of Taiwan's National Health Insurance program. From 2010 to 2017, 3571 patients ≧20 years with CP diagnosed by certified urologists were enrolled. Patients with past BPH diagnosis and diagnosis of prostate cancer, inguinal hernia, interstitial cystitis, and urethritis in the past and within one year after the first CP diagnosis were excluded. Age-matched controls were randomly selected from all non-CP individuals of the same exclusion criteria in the study period with a CP/non-CP ratio of 1:4. The follow-up was made from the first CP diagnosis to death or the end of 2018. The endpoint was the newly diagnosed BPH. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of BPH in association with CP.

RESULTS

Over a maximum of 8 years of follow-up, 287 (8.03%) and 258 (0.43%) BPH events were noted for the CP and non-CP group, respectively, representing a covariate adjusted HR (aHR) of 4.30 (95% CI, 3.61-5.13). Younger patients tended to suffer from higher aHRs, especially those aged 20-39 years (aHR: 11.45, 95% CI, 5.12-25.64).

CONCLUSION

The Taiwan national health database indicated that CP patients had a significantly higher risk of developing BPH later than non-CP patients. Interestingly, the younger the CP is diagnosed (under 40), the greater the risk.

Genetically elevated bioavailable testosterone level was associated with the occurrence of benign prostatic hyperplasia

BACKGROUND

Recent studies identified several risk factors of benign prostatic hyperplasia (BPH), including dyslipidemia, type 2 diabetes mellitus, hypertension, and obesity. But they were not so reliable and some studies contradicted with one another. Hence, a reliable method is urgently needed to explore exact factors that facilitated BPH development.

METHODS

The study was based on Mendelian randomization (MR) design. All participants were from the most recent genome-wide association studies (GWAS) with large sample size. The causal associations between nine phenotypes (total testosterone level, bioavailable testosterone level, sex hormone-binding globulin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, type 2 diabetes mellitus, hyper-tension, and body mass index) and BPH outcome were estimated. Two sample MR, bidirectional MR, and multivariate MR (MVMR) were performed.

RESULTS

Increase in bioavailable testosterone level was able to induce BPH based on nearly all combination methods [beta (95% confidence interval (CI)): 0.20 (0.06-0.34) for inverse variance weighted (IVW)]. The other traits seemed to interact with testosterone level and did not cause BPH generally. Higher triglycerides level was likely to raise bioavailable testosterone level [beta (95% CI): 0.04 (0.01-0.06) for IVW]. In MVMR model, bioavailable testosterone level was still associated with BPH occurrence [beta (95% CI) 0.27 (0.03-0.50) for IVW].

CONCLUSIONS

We for the first time validated the central role of bioavailable testosterone level in the pathogenesis of BPH. The complex associations between other traits and BPH should be further investigated.

Clinical Value of Hospital-Community-Family Integrated Nursing Model in the Treatment of Patients with Hyperlipidemia Pancreatitis

Objective

This study aimed to observe the impact of the hospital-community-family integrated nursing paradigm on the compliance, psychological state, and blood lipid levels in patients with hyperlipidemia pancreatitis (HLP).

Methods

Totally 66 HLP patients treated in our institution between June 2018 and June 2021 were randomized to Exp group and Con group. The Exp group received the hospital-community-family integrated nursing mode, whereas Con group adopted conventional nursing. Outcome measures included patient compliance, mental state, and blood cholesterol levels.

Results

Patients with integrated nursing exhibited markedly higher compliance than those with conventional nursing, as evinced by higher scores of compliance behavior, compliance awareness, medication attitude, and treatment attitude (P < 0.05). Integrated nursing offered more potent mitigation of negative emotions of patients than conventional nursing (P < 0.05). Integrated nursing resulted in better enhanced quality of life of patients versus conventional nursing (P < 0.05). Superior blood lipid amelioration was observed in patients after integration nursing versus those after conventional nursing, demonstrated by a higher serum high-density lipoprotein (HDL) level, and lower levels of triglycerides (TG), cholesterol (TC), and low-density lipoprotein (LDL) (P < 0.05). Patients were more satisfied with integrated nursing (96.97%) than conventional nursing (72.73%), suggesting a high patient acceptance of the nursing mode (P < 0.05).

Conclusion

The hospital-community-family integrated nursing model provides a viable alternative to enhance HLP patients' compliance and optimize their psychological state and blood lipid levels, demonstrating good potential for clinical promotion.

The Investigative Role of Statins in Ameliorating Lower Urinary Tract Symptoms (LUTS): A Systematic Review

Previous data have shown that patients with metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) could be refractory to the medical treatment. In this context, the evidence suggests a role for statin use in LUTS/BPE patients. The present systematic review aimed to evaluate the impact of statins on the treatment of men with LUTS/BPE. This review has been registered on PROSPERO (CRD42019120729). A systematic review of English-language literature was performed up to January 2020 in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement) criteria. Retrieved studies had to include adults with LUTS connected to BPE treated with statins drugs for metabolic syndrome. After removing duplicates, a total of 381 studies were identified by the literature search and independently screened. Of these articles, 10 fit the inclusion criteria and were further assessed for eligibility. Data from our systematic review suggest that a long-term therapy with statins, at least 6 months, is required to achieve significant impacts on prostate tissue and LUTS. Moreover, besides statins' direct activity, the risk reduction of LUTS might be connected to the improvement of hypercholesterolemia and MetS. The role of statins for the treatment of LUTS/BPE may be beneficial; however, evidence from robust studies is not enough, and more clinical trial are required.

Statins are effective in the treatment of benign prostatic hyperplasia with metabolic syndrome

OBJECTIVE

To compare the efficacy of statins and ɑ blockers drug therapies for benign prostatic hyperplasia (BPH) in patients with metabolic syndrome (MetS).

MATERIALS AND METHOD

A total of three hundred patients were randomly distributed into three groups of one hundred patients each. Group 1 received only ɑ-adrenoceptor antagonist (ɑ-blocker, AB) (Tamsulosin), group 2 received only statin (atorvastatin), and group 3 received AB plus statin (Tamsulosin + Atorvastatin). The efficacy measurement was assessed by analyzing the changes from baseline in the total International Prostate Symptom Score (IPSS), disease-specific QoL question score and maximum urinary flow rate at the end of 6 months in each group and between the three groups.

RESULTS

Pre-treatment and post-treatment value of triglycerides (TG), high-density lipoprotein (HDL), and prostate volüme (PV) were not significantly different in AB group, while TG and PV were significantly lower in patients taking statin and combined therapy. The significant decrease was demonstrated in maximum urinary flow rate (Q_max) in three groups. However, the most significant decrease was observed in the combination therapy group. IPSS, postvoid residual urine volüme (PVR), and Quality of Life score (QoL) significantly changed in three groups.

CONCLUSION

We recommend of the use of statins in those men with BPH accompanied by MetS in which AB is ineffective alone.