Serum cholesterol and risk of lower urinary tract symptoms progression: Results from the Reduction by Dutasteride of Prostate Cancer Events study

Objective: To determine if cholesterol is a risk factor for the development of lower urinary tract symptoms in asymptomatic men. Methods: A posthoc analysis of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study was carried out in 2323 men with baseline International Prostate Symptom Score < 8 and not taking benign prostatic hyperplasia or cholesterol medications. Cox proportion models were used to test the association between cholesterol, highdensity lipoprotein, lowdensity lipoprotein and the cholesterol : highdensity lipoprotein ratio with incident lower urinary tract symptoms, defined as first report of medical treatment, surgery or two reports of an International Prostate Symptom Score > 14. Results: A total of 253 men (10.9%) developed incident lower urinary tract symptoms. On crude analysis, higher highdensity lipoprotein was associated with a decreased lower urinary tract symptoms risk (hazard ratio 0.89, P = 0.024), whereas total cholesterol and lowdensity lipoprotein showed no association. After multivariable adjustment, the association between highdensity lipoprotein and incident lower urinary tract symptoms remained significant (hazard ratio 0.89, P = 0.044), whereas no association was observed for lowdensity lipoprotein (P = 0.611). There was a trend for higher cholesterol to be linked with higher lower urinary tract symptoms risk, though this was not statistically significant (hazard ratio 1.04, P = 0.054). A higher cholesterol : highdensity lipoprotein ratio was associated with increased lower urinary tract symptoms risk on crude (hazard ratio 1.11, P = 0.016) and adjusted models (hazard ratio 1.12, P = 0.012). Conclusions: Among asymptomatic men participating in the REDUCE study, higher cholesterol was associated with increased incident lower urinary tract symptoms risk, though the association was not significant. A higher cholesterol : highdensity lipoprotein ratio was associated with increased incident lower urinary tract symptoms, whereas higher highdensity lipoprotein was protective. These findings suggest dyslipidemia might play a role in lower urinary tract symptoms progression.