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Men who have heart disease are at increased risk of BPH, but intense physical exercise may reduce the risk

Benign prostatic hyperplasia (BPH), which involves frequent or difficult urination and an enlarged or swollen prostate, affects one-third of men 60 to 70 years of age. Among healthy aging men, elevated levels of free prostate-specific antigen (PSA) and diagnosed heart disease increase the likelihood of BPH, while physical exercise and current cigarette smoking appear to reduce the risk, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS08397).

The Prostatic Diseases Patient Outcomes Research Team (PORT), led by Michael J. Barry, M.D., of Harvard Medical School, examined risk factors for BPH based on the Massachusetts Male Aging Study. From 1987 to 1989, 1,709 men aged 40 to 70 provided baseline risk factor data and were followed for a mean of 9 years; 1,019 men without prostate cancer provided followup data.

Nearly one-fifth (19 percent) of men had been diagnosed with BPH or had undergone surgery for the condition at followup, increasing from 8 percent of men aged 38-49 years to 34 percent of men aged 60-70 years. After adjustment for age, men in the top quartile for free PSA levels had five-fold increased odds of developing BPH, and men with heart disease or use of beta-blocker medications doubled or nearly doubled their odds for BPH. This link between coronary heart disease and BPH is a novel finding, suggesting a potential vascular etiology for development of BPH.

On the other hand, current cigarette smoking of a pack a day and high levels of physical activity (those in the highest quartile of activity) decreased their odds of BPH by half. Total or fat calorie intake, sexual activity level, alcohol intake, body mass index, waist-hip ratio, diastolic blood pressure, a history of diabetes, hypertension, vasectomy, or serum levels of androgens or estrogens did not affect development of BPH.

See "Risk factors for clinical benign prostatic hyperplasia in a community-based population of healthy aging men," by James B. Meigs, M.D., M.P.H., Beth Mohr, M.S., Dr. Barry, and others, in the September 2001 Journal of Clinical Epidemiology 54, pp. 935-944.

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