Urology

Prevalence of metabolic syndrome and its components among men with and without clinical benign prostatic hyperplasia: a large, cross-sectional, UK epidemiological study

DiBello JR, Ioannou C, Rees J, Challacombe B, Maskell J, Choudhury N, Kastner C, Kirby M. BJU Int 2016; 117(5): 801–808.

Benign prostatic hyperplasia and metabolic syndrome

Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are common progressive conditions that can substantially affect men’s quality of life.1 Metabolic syndrome comprises a cluster of risk factors for cardiovascular disease, which is a major public health concern that affects approximately 25% of adults.1

Association between BPH and metabolic syndrome

Previous studies have suggested an association between clinical BPH and the presence of metabolic syndrome in terms of the severity of BPH-related LUTS.1 Researchers from the UK compared the prevalence of metabolic syndrome components in men with and without clinically diagnosed BPH in a cross-sectional study.1 This is thought to be the largest study of its kind, comprising over 170,000 individuals.1 Data were obtained from the UK Clinical Practice Research Datalink (CPRD).1

Methods and study design

Metabolic syndrome was defined as body mass index >30 kg/m2, and 2 out of 5 of the following parameters: raised triglyceride levels, raised fasting plasma glucose, diabetes, reduced high-density lipoprotein cholesterol levels or hypertension.1

Data were obtained from CPRD for men with clinical BPH who were still registered as of 31 December 2011 and who were aged ≥50 years.1

Significantly more men with BPH had metabolic syndrome compared with matched controls (26.5% versus 20.9%; p<0.001).1

Patients were split into 2 cohorts. Cohort 1 comprised 85,103 men with clinically diagnosed BPH, and cohort 2 comprised 85,103 men with no BPH or LUTS, who were matched 1:1 with cohort 1 by year of birth, general practice and years of history available.1

Approximately 70% of men with BPH were aged 60–79 years, and 82% of all patients had 9 or more years of medical history available.1

Clinical BPH and metabolic syndrome components

Significantly more men with clinical BPH exhibited each component of metabolic syndrome compared with controls (p<0.001 for all comparisons between cohorts).1 Elevated prostate-specific antigen (PSA) lowered the odds of all components of metabolic syndrome.1

Pre-diabetes was significantly more prevalent in men with clinical BPH compared with men without BPH (2.0% versus 1.4%; p<0.001).1

Clinical BPH increased the odds of having metabolic syndrome by 37% both for lifetime and current prevalence compared with matched controls without BPH.1

Impact of alcohol intake and smoking in men with BPH

Of the 23.4% of men with clinical BPH who showed moderate/high alcohol intake, 30% had a higher likelihood of having metabolic syndrome compared with those with low or no alcohol intake.1

The study showed that 63.9% of men with clinical BPH had a lifetime history of smoking.1 Of these men, there was an 82% higher likelihood of having metabolic syndrome, along with increased odds of having each of the metabolic syndrome components compared with those with no history of smoking.1

The authors acknowledged that the patients analysed in this study were more likely to have a history of smoking compared with the general UK population because they lived in an era when smoking was common.1

History of elevated PSA in men with clinical BPH reduced the odds of having metabolic syndrome by 22%.

The authors concluded that there was an association between clinical BPH and metabolic syndrome, which could provide an opportunity for physicians to improve men’s health.1

Report on: Prevalence of metabolic syndrome and its components among men with and without clinical benign prostatic hyperplasia: a large, cross-sectional, UK epidemiological study. DiBello JR, Ioannou C, Rees J, Challacombe B, Maskell J, Choudhury N, Kastner C, Kirby M. BJU Int 2016; 117(5): 801–808.