Viagra, erectile dysfunction drugs linked to 25% lower risk of death in healthy men

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A new study finds that erectile dysfunction medications are associated with a lower cardiovascular risk in healthy men.
Image credit: STUDIO TAURUS/Stocksy.
  • Medications to treat erectile dysfunction that contain phosphodiesterase type 5 (PDE-5i) inhibitors have broader health benefits in men with type 2 diabetes and/or known heart conditions.
  • PDE-5i drugs include sildenafil, vardenafil and tadalafil.
  • New research now shows that PDE-5i treatment for erectile dysfunction is associated with a significant reduction in the risk of major adverse cardiovascular events and death in healthy men.

Doctors usually treat erectile dysfunction (ED) by prescribing drugs containing phosphodiesterase type 5 inhibitors (PDE-5i), which reduce the amount of phosphodiesterase 5 (PDE-5) in the body.

A lack of PDE-5 increases the amount of cyclic guanosine monosulfate – a molecule that promotes relaxation of smooth muscles in artery walls, leading to vasodilation, increased blood flow and improved circulation.

PDE-5i drugs include:

Studies into the broader impact of PDE-5i have shown that it has renoprotective (kidney protective) benefits, improves endothelial cell function, and reduces age-related mortality in people with type 2 diabetes.

PDE-5i treatment for erectile dysfunction after a first heart attack has also been associated with a 33% reduced risk of death and 40% reduction in hospitalization for heart failure.

Separate studies in men with stable coronary artery disease (CAD), PDE-5i treatment was associated with lower risks of death, heart attack, and heart failure.

Until now, most studies have involved men with known heart conditions or type 2 diabetes. Now, new collaborative research between the Huntington Medical Research Institutes and the University of California has shown that PDE-5i may also have cardioprotective effects in men. healthy.

The study appears in The journal of sexual medicine.

The retrospective observational study lasted 14 years and included 72,498 men with a diagnosis of ED, nearly 24,000 of whom were receiving PDE-5i treatment.

Pharmaceutical and medical data drawn from the HealthCore Integrated Research Database highlighted men taking PDE-5 inhibitors – sildenafil, vardenafil, tadalafil and/or avanafil once during the study period, but not within the first 12 months.

People with previous major adverse cardiovascular events (MACE) or who were prescribed medication for pulmonary hypertension were excluded from the study.

The research team found that men taking PDE-5i drugs were 13% less likely to experience a cardiac event, which was linked to a reduction in coronary revascularization, heart failure and unstable angina.

Overall mortality was reduced by 25% in men exposed to PDE-5i and the team reported a 39% lower risk of dying from cardiovascular causes.

Similar reduced major adverse cardiac events (MACE) – cardiovascular disease-related death, hospitalization for heart attack, coronary revascularization, stroke, heart failure and unstable angina – and mortality findings occurred in participants without CAD but with risk factors for known cardiovascular disease who had been exposed to PDE-5i.

The reduction in MACE, heart attack, and stroke was greatest in men taking the most of these drugs during the study period, with a 55% reduction in MACE and a 49% reduction in overall mortality observed.

Talking to medical news todayThe lead author of the study, Dr. Robert A Kloner explained:

“We found a greater benefit in MACE at higher doses. However, our study was a retrospective study and until a multi-dose prospective placebo-controlled study is performed, we cannot recommend doses. Furthermore, we are not suggesting that PDE-5 inhibitors be used off-label. They should only be used for the treatment of ED or pulmonary hypertension, on the label, at recommended doses.”

The Doctor. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica who was not involved in the study, said MNT that prescriptions for erectile dysfunction medications are increasing.

“Erectile dysfunction medications are increasingly being prescribed,” he noted, and “taken as needed, whereas cardiac therapies are typically taken regularly, so the assumption is that the level of exposure to PDE5 inhibition may not be as high. ”.

Men with type 2 diabetes receiving PDE-5i medication also had a lower incidence of MACE, as did men diagnosed with CAD, but the trend was not significant.

The research team explained that this may be due to the small number of participants in the subgroups.

The authors also note that the retrospective nature of the study precludes them from establishing the cause of the link and that PDE-5i exposure is estimated from dispensed tables which may not be accurate as the pills may not have been taken or may also have been taken. have been obtained from another source.

“[F]taking a drug does not necessarily mean taking it,” cautioned Dr. Tadwalker.

He also commented that “[a] The big possible confounder in this study is whether those who were taking PDE5 inhibitors might also be engaging in increased sexual activity and whether sexual activity itself was providing benefits, independent of the drug’s effects.”

The study did not collect information about participants’ relationship status or levels of sexual satisfaction.

This group of drugs was originally developed to treat angina, and it was only when men taking the drug for that condition reported it being easier to get and maintain an erection as an added effect, that researchers investigated its role in treating erectile dysfunction.

This study did not look at the drug’s effect on women, but PDE-5i is also prescribed for women with pulmonary hypertension. Could PDE-5i have similar cardioprotective potential in women?

“We didn’t have data on the use of PDE-5 inhibitors in women in our study, so we don’t know if there’s a cardioprotective effect similar to what we saw in men with erectile dysfunction,” said Dr. kloner MNT. “However, we know that these drugs work for pulmonary hypertension and that includes women.”

“Some doctors also use these drugs to treat Raynaud’s syndrome, which can also work in women. Future studies will need to be done in which women are given placebo versus PDE-5 inhibitors and then the effect on cardiovascular events is determined,” she advised.

The Doctor. Tadwalker explained that previous research has highlighted the importance of sex differences in PDE-5i action.

“We use PDE5 inhibitors regularly in both men and women for a condition called pulmonary arterial hypertension (PAH),” he pointed out. “Using the medication results in reduced pulmonary vascular tone, allowing for greater blood flow to the lungs.”

“Although not specifically confirmed, some studies have suggested that PDE5 inhibitors may be less effective in treating PAH in women compared to men,” he cautioned. “However, as we give these drugs to women with this condition, the hope is that it will also work in an at-risk general population to reduce rates of serious adverse cardiovascular events.”

This study shows that PDE-5i is associated with lower rates of cardiovascular events in healthy men, supporting previous studies that reported cardioprotective benefits in men with type 2 diabetes and known cardiovascular disease. The next step is the completion of randomized controlled clinical trials.

“What is needed now is a large, prospective, randomized, placebo-controlled trial evaluating whether these agents reduce major adverse cardiovascular events, conducted over several years,” commented Dr. Kloner.

The need for studies with “high quality randomized data” was repeated by Dr. Tadwalker.

“The clinical implications are positive, especially as the effect sizes look quite large,” he told us. “We have not thought about the routine use of PDE5 inhibitors in this context before. We may be more inclined to encourage the use of these drugs in our at-risk and cardiovascular patients who choose to take them, as long as there are no significant contraindications.”

However, according to Dr. Kloner, this may not be so simple.

“The problem is finding funding for such a study. Since most of these drugs are now generic, there will be less interest from pharmaceutical companies to fund this type of study,” he explained.

However, he hopes the results of these studies could encourage government funding.

“It would be great if the government (NIH) was interested. […] Perhaps some of these more recent retrospective studies, which have shown very consistent and positive results, will again spark interest in funding these drugs for new indications from various sources,” said Dr. Kloner.

Viagra, erectile dysfunction drugs linked to 25% lower risk of death in healthy men

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