Circulating levels of blood biomarkers and risk of benign prostatic hyperplasia: Results from two large cohorts in Europe and East Asia.

Background: As one of the most prevalent chronic non-communicable diseases affecting aging males, the burden of benign prostatic hyperplasia is growing over the world. Our study aims at investigating the potential relationships between various blood biomarkers and benign prostatic hyperplasia (BPH) in middle-aged and older men in European and East Asian population cohorts.

Methods: We included 229 022 male adults from the UK Biobank (UKB) and 20 284 male adults from the China Health and Retirement Longitudinal Study (CHARLS) in this study. Forty-four blood biomarkers in UKB cohort and 16 blood biomarkers in the CHARLS cohort were analysed to examine their association with benign prostatic hyperplasia. Cox, logistic analyses and restricted cubic spline models were used to investigate linear and nonlinear longitudinal associations.

Results: In our research, elevated high-density lipoprotein cholesterol showed significant associations with a decreased risk of benign prostatic hyperplasia, and these associations remained significant after accounting for potential covariates both in UKB cohort (hazard ratio (HR) = 0.83; 95% CI = 0.79-0.88, P < 0.001) and CHARLS cohort (odds ratio (OR) = 0.992; 95% CI = 0.985-0.999, P = 0.033). Apolipoprotein A was also found to be inversely associated with BPH (HR = 0.76; 95% CI = 0.70-0.81, P < 0.001). L-shaped relationships were discovered between level of high-density lipoprotein cholesterol and apolipoprotein A with incidence of benign prostatic hyperplasia.

Conclusions: This large prospective biomarker-based study highlights that high-density lipoprotein (HDL) cholesterol and apolipoprotein A are significant protective factors against the development of BPH, with L-shaped associations suggesting an optimal protective range. In contrast, biomarkers related to glucose metabolism, inflammation, and hormone levels were not found to significantly influence BPH progression. Our findings support the potential involvement of lipid biomarkers in the early stages of BPH development, suggesting that future strategies should prioritise lipid-related pathways in the prevention and management of BPH.