Finasteride delays atherosclerosis progression in mice and is associated with a reduction in plasma cholesterol in men

Finasteride is commonly prescribed to treat benign prostate hyperplasia and male-pattern baldness in cis men and, more recently, trans individuals. However, the effect of finasteride on cardiovascular disease remains elusive. We evaluated the role of finasteride on atherosclerosis using low-density lipoprotein (LDL) receptor-deficient (Ldlr-/-) mice. Next, we examined the relevance to humans by analysing the data deposited between 2009 and 2016 in the National Health and Nutrition Examination Survey (NHANES). We show that finasteride reduces total plasma cholesterol and delays the development of atherosclerosis in Ldlr-/- mice. Finasteride reduced monocytosis, monocyte recruitment to the lesion, macrophage lesion content, and necrotic core area, the latter of which is an indicator of plaque vulnerability in humans. RNA sequencing analysis revealed a downregulation of inflammatory pathways and an upregulation of bile acid metabolism, oxidative phosphorylation, and cholesterol pathways in the liver of mice taking finasteride. Men reporting the use of finasteride showed lower plasma levels of cholesterol and LDL-cholesterol than those not taking the drug. Our data unveil finasteride as a potential treatment to delay cardiovascular disease in people by improving the plasma lipid profile. Male Ldlr-/- were fed Western diet without finasteride or the same diet supplemented with 1000 mg finasteride/kg for 12 weeks. After 12 weeks on a diet, mice were fasted overnight and euthanized. Upon harvesting, tissues were immediately placed in liquid nitrogen and stored at -80ºC. Liver RNA was isolated using a Zymo Research mini prep tissue kit (Irvine, CA), following a DNaseI treatment, according to the manufacturer's instructions.