Main Article Content
Case-control studies, elderly, epidemiology, benign prostatic hyperplasia, furosemide, diuretic
Recent studies have shown that furosemide may have anti-inflammatory properties. We explored whether exposure to furosemide would reduce the risk of being hospitalized with prostatism, a marker of benign prostatic hyperplasia.
Using record linkage and the computerized health insurance databases of the province of Québec, Canada, we identified a cohort of men 65 years of age and older within which we conducted a case-control study. Cases were individuals hospitalized with prostatism (ICD-9 code 600) between January 1991 and June 1993, with the index date taken as the date of hospitalisation. Controls were those not having experienced the event during the study period, with an index date selected randomly during their follow-up. Cases and controls were required to have at least 2 ½ years of health coverage prior to index date in order to identify risk factors for benign prostatic hyperplasia and establish baseline medical history. We assessed the subjects’ exposure to furosemide and various other diuretics in the period 180 to 900 days preceding the index date. Logistic regression was used to evaluate the association between the use of furosemide and hospitalization for prostatism, adjusting for potential confounders.
The cohort included 8,814 subjects, of which 231 were cases and 8,583 controls. The rate of hospitalization for prostatism was lower for users of furosemide compared to non-users (adjusted rate ratio 0.49; 95% CI: 0.25–0.95). There was no association with the use of thiazide or potassium sparing diuretics (adjusted rate ratio 0.95; 95% CI: 0.65–1.37). Results suggestive of a protective effect associated with corticosteroid use were observed (adjusted rate ratio 0.64; 95% CI: 0.44–0.93).
This study supports the hypothesis that furosemide can reduce the risk of hospitalization for prostatism, a marker of benign prostatic hyperplasia.
2. Shvartzman P, Borkan JM, Stoliar L, Peleg S, Nakar S, Nir G, Tabenkin H. Second-hand prostatism: effects of prostatic symptoms on spouses’ quality of life, daily routines and family relationships. Fam Practice 2001; 18:610-613.
3. Hunter DJW, McKee M, Black NA, Sanderson CFB. Health status and quality-of-life of British men with lower urinary-tract symptoms – results from the SF-36. Urol. 1995; 45:962-971.
4. Cabelin MA, Te E, Kaplan SA. Benign prostatic hyperplasia: challenges for the new millennium. Curr Opin Urol 2000; 10:301-306.
5. Di Silverio F, Gentile V, De Matteis A et al. Distribution of inflammation, pre-malignant lesions, incidental carcinoma in histologically confirmed benign a prostatic hyperplasia: a retrospective analysis. Eur Urol. 2003 Feb; 43(2):164-175.
6. Yuengrigul A, Chin TW, Nussbaum E. Immosupressives and cytotoxic effects of furosemide on human peripheral blood mononuclear cells. Ann Allergy Asthma Immunol 1999; 83:559-566.
7. Lakhani M, Usmanu SS, Wapnir RA, Harper RG. In vitro effect of furosemide on the chemiluminescence of polymorphonuclear neutrophils in preterm infants. Biol Neonate 1997; 72:142-147.
8. Prandata J. Furosemide: progress in understanding its diuretic, anti-inflammatory, and bronchodilating mechanism of action, and use in the treatment of respiratory tract diseases. Am J Ther 2002; 9:317-328.
9. Hemmelgarn B, Suissa S, Huang A Boivin JF, Pinard G. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA 1997;
10. Garbe E, Boivon JF, LeLorier J, Suissa S. Selection of controls in database case-control studies: glucocorticoids and the risk of glaucoma. J Clin Epidemiol 1998; 51(2):129-135.
11. Garbe E, Suissa S, LeLorier J. Exposure to allopurinol and the risk of cataract extraction in elderly patients. Arch Ophthalmol 1998; 116(12):1652-1656.
12. Garbe E, LeLorier J, Boivin JF, Suissa S. Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open angle glaucoma. JAMA
13. Tamblyn R, Lavoie G, Petrella L, Monette J. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claimsdatabase in Quebec. J Clin Epidemiol 1995; 48:999-1009.
14. Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol 1992; 45:197-203.
15. SAS Institute. North Carolina. USA.
16. Suissa S, Bourgault C, Barkun A, Sheehy O, Ernst P. Antihypertensive drugs and the risk of gastrointestinal bleeding. Am J Med 1998;105:230-5