Statin usage may defer the development of lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE) by up to seven years.

The Olmsted County study, a huge cohort study that has been running in Minnesota for many years, has produced several important urological papers. The Olmsted County database was used to carry out a retrospective study of almost 2,500 men, aged 40-79 years, from 1990 to 2007.

A total of 2,447 patients were followed for a median of 13.8 years of whom 729 (30%) reported statin usage during the study. Statin users had a lower cumulative incidence of moderate/severe LUTS during the study compared with those who did not use statins. This difference was maintained even after adjusting for differences in rates of CHD, diabetes, hypertension, age, smoking, BMI, alcohol use, NSAID use and activity levels.

There was a clear inverse relationship between statin usage and the development of LUTS with a hazard ratio of 0.39 (95% CI: 0.31 -0.49) and BPE, HR 0.40 (95% CI: 0.23-0.69). Overall, statin usage was associated with a 6.5 to 7 year delay in the new onset of moderate/severe LUTS or BPE.

Inflammatory processes may be involved in the development of LUTS and BPE.

The mechanism of action of statins is complex but evidence suggests they have significant anti-inflammatory properties. Although not statistically significant, those patients taking both statins and NSAIDs had the lowest overall incidence of developing LUTS, which would appear to support an anti-inflammatory hypothesis.

This study has significant flaws, most notably that it is a retrospective cohort study rather than a randomised controlled trial. Furthermore, the Olmsted County population is a largely affluent Caucasian community, and therefore it is unclear as to whether these results would apply across other ethnic and socio-economic groups. However, the results are interesting at a time of ever increasing statin prescription. There is a potential for vast public health benefit if the findings of this study were reproduced across our at-risk population.

Dr Jonathan Rees