In an innovative study published in the Journal of Lipid Research, scientists have discovered that finasteride, a drug commonly used to treat benign prostate hyperplasia and male-pattern baldness in cis men and increasingly in trans individuals, may have significant benefits for cardiovascular health. This research, led by S.S. Virani and colleagues, highlights the potential of finasteride to reduce plasma cholesterol levels and delay the progression of atherosclerosis, a leading cause of cardiovascular disease (CVD), the number one killer globally.
The study’s findings are particularly timely, given the increasing prevalence of CVD and the ongoing search for effective treatments that can mitigate risk factors associated with heart disease. Atherosclerosis, characterized by the accumulation of cholesterol-rich lipoproteins in the arterial walls leading to the formation of plaques, is a primary contributor to CVD. These plaques can eventually lead to occlusions or rupture, causing life-threatening events like stroke, peripheral artery disease, and coronary heart disease.
The researchers embarked on a two-pronged approach to investigate finasteride’s effects on cardiovascular health. Initially, they examined its impact on atherosclerosis progression in low-density lipoprotein (LDL) receptor-deficient mice, a model known for its susceptibility to the disease. The mice treated with finasteride exhibited notable reductions in total plasma cholesterol and showed delayed development of atherosclerotic lesions. Mechanistically, finasteride treatment led to decreased monocytosis, reduced monocyte recruitment to lesions, diminished macrophage lesion content, and smaller necrotic core areas, indicating a reduction in plaque vulnerability.
To complement the animal study and assess the relevance of these findings to humans, the team analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2016. The analysis revealed that men who reported using finasteride had lower levels of plasma cholesterol and LDL-cholesterol compared to those not taking the drug. This retrospective human study aligns with the animal model findings, suggesting finasteride’s potential to improve plasma lipid profiles and, by extension, reduce the risk of CVD.
RNA sequencing analysis of liver samples from mice treated with finasteride provided further insights into the drug’s mechanisms of action. The analysis showed a downregulation of inflammatory pathways and an upregulation of bile acid metabolism, oxidative phosphorylation, and cholesterol pathways. These molecular changes suggest that finasteride’s cardiovascular benefits may stem from its ability to modulate lipid metabolism and inflammation, key factors in the development and progression of atherosclerosis.
The discovery of finasteride’s potential cardiovascular benefits opens new avenues for research and therapy. Given the drug’s widespread use and established safety profile, these findings could have immediate clinical implications. However, the researchers caution that more studies are needed to fully understand finasteride’s mechanisms of action and its long-term impact on cardiovascular health.
This research not only sheds light on a potential new use for a well-known drug but also underscores the complex interplay between hormonal regulation and cardiovascular health. By revealing that a drug used to treat conditions related to sex hormone regulation can have significant effects on cholesterol metabolism and atherosclerosis, the study contributes to a broader understanding of CVD pathogenesis. It also highlights the importance of considering hormonal factors in the development of therapeutic strategies for preventing and treating heart disease.
Journal Reference –Author links open overlay panelPatrick McQueen 1 ‡, 1, 2, 3, 4, & AbstractFinasteride is commonly prescribed to treat benign prostate hyperplasia and male-pattern baldness in cis men and. (2024). Finasteride delays atherosclerosis progression in mice and is associated with a reduction in plasma cholesterol in men. Retrieved from https://www.sciencedirect.com/science/article/pii/S0022227524000129
