It is unknown whether dyslipidaemia causes benign prostatic hyperplasia (BPH) and erectile dysfunction, or if it is merely a marker of endothelial dysfunction causing these conditions.

A prospective cohort study from the US, nested within a large community study, has looked at the association between serum lipids and lipoproteins and BPH.

The study recruited 699 men aged ≥ 60, of whom 531 met the inclusion criteria. The main excluding factor was the presence or suspicion of prostate cancer.

During the four-year study period, 48% of participants reported a diagnosis of BPH or non-cancer prostate surgery. Men diagnosed with BPH were significantly older (mean age 75.8 versus 72.7 years, P= <0.001).

Serum lipid and lipoprotein concentrations did not differ significantly between men with clinical BPH and those without. No associations with BPH and triglycerides or HDL cholesterol were found.

However, in men with diabetes, the risk of BPH in those with clinically raised LDL cholesterol was twice that for men with normal LDL cholesterol levels. Patients with a serum LDL cholesterol >133mg/dl were four times more likely to have BPH than those with a serum LDL cholesterol <110mg/dl (P= 0.02).

The authors postulate that there could be a synergistic interaction of high LDL cholesterol with insulin resistance, which predisposes men with diabetes to BPH.

This raises the question of whether lowering LDL cholesterol levels with statins would be protective against BPH. Although a large study of patients with BPH treated with atorvastatin for six months found that statin therapy had no effect on urinary symptoms,¹ a similar study in patients with diabetes might yield a different result.

There is a long way to go in understanding the relationship between lipids, cardiovascular risk and BPH. The findings of this study are consistent with the concept that cardiac risk factors are involved in the pathogenesis of BPH, but we are far from a proven, well understood link.

Parsons JK, Bergstrom J, Barrett-Connor E. Lipids, lipoproteins and the risk of benign prostatic hyperplasia in community-dwelling men. BJU Int 2007;101:313-8