Use of 5-alpha reductase inhibitors but not androgen deprivation therapy was associated with a lower risk of severe complications after PCI-treated STEMI in men.
Key Findings
Results
Men treated with 5-alpha reductase inhibitors (5αRIs) had significantly lower odds of experiencing severe complications after PCI-treated STEMI compared to matched controls.
Odds ratio for severe complications in 5αRI-treated men was 0.80 (95% CI, 0.69-0.93)
1305 men treated with 5αRI (mean age 74.2 [SD 6.7] years) were matched to 6463 control patients using propensity score matching
The primary outcome was a composite of 30-day mortality and severe in-hospital complications including cardiac arrest and resuscitation, atrioventricular block stage II or III, cardiogenic shock, new-onset atrial fibrillation or flutter, severely depressed left ventricular function, or mechanical complication
Data were drawn from a nationwide, registry-based cohort study in Sweden from January 2006 to December 2022
Results
Men treated with androgen deprivation therapy (ADT) did not show a significant association with severe complications after PCI-treated STEMI compared to matched controls.
Odds ratio for severe complications in ADT-treated men was 1.10 (95% CI, 0.83-1.45), which was not statistically significant
358 men treated with ADT (mean age 76.2 [SD 6.2] years) were matched to 1774 control patients using propensity score matching
The divergent findings between 5αRI and ADT suggest the mechanism may not be solely attributable to lowering androgen levels, as ADT more profoundly suppresses testosterone
Methods
The study population consisted of men aged 35 to 84 years with first-time STEMI treated with PCI across Sweden over a 16-year period.
Study period spanned January 2006 to December 2022
Only men with first-time STEMI treated with percutaneous coronary intervention (PCI) were included
Age range was restricted to 35 to 84 years
Conditional logistic regression was used to calculate odds ratios following propensity score matching
Data were analyzed in June 2026
Background
Male sex and endogenous testosterone have been shown to exacerbate neutrophilia and cardiac injury in myocardial infarction, providing the biological rationale for studying androgen-modulating drugs in STEMI.
Prior research demonstrating that male sex and endogenous testosterone worsen neutrophilia and cardiac injury in MI motivated the study hypothesis
The study examined whether drugs that lower androgen actions could be protective in the acute STEMI setting
5αRIs reduce the conversion of testosterone to the more potent dihydrotestosterone, whereas ADT suppresses testosterone production more broadly
Discussion
The divergent results between 5αRI and ADT use suggest that the protective association of 5αRI may not be purely mediated through androgen level reduction.
5αRIs lower dihydrotestosterone but do not eliminate testosterone, whereas ADT more broadly suppresses androgen levels
The authors concluded these results 'warrant further research into the role of androgens and drugs that affect androgen levels in the acute phase of STEMI'
The differing outcomes between the two drug classes raise questions about whether the 5αRI benefit involves mechanisms beyond androgen modulation
What This Means
This research suggests that men who were already taking a class of drugs called 5-alpha reductase inhibitors (5αRIs) — commonly prescribed for enlarged prostate or male-pattern hair loss — had about a 20% lower chance of experiencing serious complications or dying within 30 days after a severe heart attack (called a STEMI) treated with a procedure to open blocked arteries. The study tracked over 17,000 Swedish men between 2006 and 2022, carefully matching drug users with similar men who were not taking these drugs to make the comparison as fair as possible. Serious complications included events like cardiac arrest, dangerous heart rhythm problems, cardiogenic shock, and severely weakened heart pumping function.
Interestingly, men taking a different type of androgen-lowering treatment called androgen deprivation therapy (ADT), typically used to treat prostate cancer by strongly suppressing testosterone, did not show a similar protective effect. This unexpected difference between the two drug types suggests the benefit seen with 5αRIs may not be simply due to lowering male hormone (androgen) levels, since ADT lowers androgens much more dramatically. Scientists believe male hormones may worsen the body's inflammatory response and heart damage during a heart attack, and 5αRIs specifically block conversion of testosterone into a more potent form called dihydrotestosterone.
This research suggests that the biology of male hormones during heart attacks is more complex than previously understood and that the specific type of hormone modification matters. The findings open up new questions about whether androgen-related pathways could be targeted to improve outcomes after severe heart attacks in men, and the authors call for further research to understand the underlying mechanisms before any clinical conclusions can be drawn.