TOPLINE:

In a large study, the oral 5-alpha-reductase inhibitors (5ARI) finasteride and dutasteride were not associated with a higher risk for composite or individual cardiovascular disease (CVD) outcomes in patients with androgenetic alopecia (AGA) over 5 years.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using the US TriNetX network database to analyze 24,424 patients with AGA who were treated with finasteride or dutasteride. The mean patient age was 41.7 years; 76.7% were men; 75.5% were White, 4.7% were Black, and 6.6% were Hispanic individuals.
• The propensity score-matched analysis included an equal number of untreated control individuals.
• The primary outcome was composite CVD and individual cardiovascular events over 1-, 3-, and 5-years of follow-up.

TAKEAWAY:

• Oral 5ARI use was not associated with an increased risk for composite CVD at any follow-up interval (hazard ratio [HR], 0.997; P = .916 at 5 years).
• At 1-, 3-, and 5-year follow-ups, 5ARI exposure was not associated with an increased risk for any individual cardiovascular outcome.
• At 5 years, the risk for atrial fibrillation was significantly reduced among treated patients (HR, 0.713; P < .001).
• Other outcomes, including all-cause mortality, coronary artery disease, peripheral vascular disease, and myocardial infarction, were associated with lower risk estimates among those treated with 5ARIs but were not statistically significant after correction. 

IN PRACTICE:

“Although the pathophysiologic mechanisms underlying potential cardiovascular effects of 5ARI remain incompletely understood, these findings further support growing evidence regarding the cardiovascular safety of finasteride and dutasteride,” the study authors wrote. “Consistent absence of elevated cardiovascular harm across multiple outcomes and follow-up intervals,” they added, “provides reassurance regarding long-term 5ARI use in appropriately selected AGA patients.”

SOURCE:

The study was led by Archie Spindler, Department of Dermatology, New York University School of Medicine in New York City, and was published online on April 24 as a brief report in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The study used a retrospective database design and was subject to residual confounding despite propensity score-matching. Medication adherence could not be confirmed, and healthy-user bias might have influenced results.

DISCLOSURES:

The study did not receive any specific funding. Some authors disclosed serving as investigators and consulting for Pfizer, Regen, Lilly, Ro, Priovant, Veradermics, and Aquis. No other authors reported relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.