Absence of Interaction Between 5α‐Reductase Inhibitors and Glucocorticoids on Incidence of Myocardial Infarction in People With Type 2 Diabetes
Authors' conclusion
People with Type 2 diabetes exposed to 5α-reductase inhibitors or glucocorticoids are at an increased risk of myocardial infarction, although a multiplicative interaction between the use of the two drugs was not found.
Study context
- Population
- Patients with T2D aged ≥40 years receiving 5α-reductase inhibitors or tamsulosin, incident users of systemic glucocorticoids 2006–2021; SDRN-NDS (Scotland) and IQVIA Medical Research Data-UK (IMRD-UK)13,161 SDRN-NDS
- Exposure
- 5α-reductase inhibitors vs tamsulosin, with cumulative systemic glucocorticoid exposure
- Outcome
- MI: joint effect of 5α-reductase inhibitors and cumulative glucocorticoid exposure (multiplicative interaction)
Methodological detailstime-varying Cox proportional hazards model, two databases (SDRN-NDS and IMRD-UK), Mean age 71.4 ± 9.6 (SDRN-NDS) and 72.3 ± 9.4 years (IMRD-UK); mean follow-up 4.7 (3.6) and 5.6 (4.0) years
- Time-varying Cox proportional hazards model
- Two databases (SDRN-NDS and IMRD-UK)
- Mean age 71.4 ± 9.6 (SDRN-NDS) and 72.3 ± 9.4 years (IMRD-UK); mean follow-up 4.7 (3.6) and 5.6 (4.0) years
Main finding
As reported in the abstract
- No multiplicative interaction, SDRN-NDS
- p = 0.44
- No multiplicative interaction, IMRD-UK
- p = 0.68
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| MI risk with 5α-reductase inhibitor use5α-reductase inhibitorsvs TamsulosinSDRN-NDS | 1.21 (1.02–1.43) | |
| MI risk with 5α-reductase inhibitor use5α-reductase inhibitorsvs TamsulosinIMRD-UK | 1.27 (1.02–1.59) | |
| MI risk per SD increase in cumulative glucocorticoid exposurePer SD increase in cumulative glucocorticoid exposure · SDRN-NDS | 1.09 (1.03–1.14) | |
| MI risk per SD increase in cumulative glucocorticoid exposurePer SD increase in cumulative glucocorticoid exposure · IMRD-UK | 1.08 (1.01–1.15) | |
| 0.512Hazard ratio (log scale) |
Total glucocorticoid exposure (prednisolone-equivalent mg)
- Median (IQR), SDRN-NDS
- 210 (96-630)
- Median (IQR), IMRD-UK
- 420 (200-1240)
Original publication
Absence of Interaction Between 5α‐Reductase Inhibitors and Glucocorticoids on Incidence of Myocardial Infarction in People With Type 2 Diabetes. Diabetes Obes Metab. Published 3 August 2026. doi:10.
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