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“Viagra” could prolong the lives of men with heart problems and reduce the risk of having a new heart attack


(Shutterstock)

Men with stable coronary artery disease who take Viagra for impotence may live longer and have a lower risk of a new heart attack, according to a study prepared from the Karolinska Institutet, in Sweden, published in the Journal of the American College of Cardiology.

Impotence can be an early warning sign of cardiovascular disease in healthy men and is treated locally with alprostadil, which dilates the blood vessels to make the penis hard, or with so-called phosphodiesterase-5 (PDE5) inhibitors, such as Viagra or Cialis, which are taken in pill form taken by mouth before sexual intercourse, inhibiting the PDE5 enzyme in the penis to increase blood flow.

Since PDE5 enzyme inhibitors lower blood pressure, they were previously not recommended for men with coronary artery disease due to the risk of heart attack.

However, in 2017, cardiologist Martin Holzmann, Associate Professor of Epidemiology in the Solna Department of Internal Medicine at the Karolinska Institutet, together with a group of colleagues demonstrated that men who have had a heart attack tolerate the drug well and it can even extend life expectancy, since it protects them against new heart attacks and heart failure.

"Men who received PDE5 inhibitors lived longer and had a lower risk of a new heart attack, heart failure, balloon dilatation and bypass surgery than those who received alprostadil" (Shutterstock)
“Men who received PDE5 inhibitors lived longer and had a lower risk of a new heart attack, heart failure, balloon dilatation and bypass surgery than those who received alprostadil” (Shutterstock)

In his new study, Association of phosphodiesterase-5 inhibitors versus alprostadil with survival in men with coronary artery disease, recently published, researchers sought to compare the effect of alprostadil and PDE5 inhibitors in men with stable coronary artery disease. Patients must have had a heart attack, balloon dilation, or coronary artery bypass surgery at least six months prior to the start of erectile dysfunction treatment.

“The risk of a new heart attack is higher during the first six months, after which we consider that the coronary artery disease is stable,” said Holzmann, lead author of the research, which also included Daniel Andersson, Laura Landucci, Ylva Trolle Lagerros, Alessandra Grotta, Rino Bellocco, and Mikael Lehtihet.

The study looked at 16,548 men treated with PDE5 inhibitors and 1994 who received alprostadil. Data were obtained from patient, drug, and cause of death registries.

The mean follow-up was 5.8 years, with 2261 deaths (14%) in the PDE5 inhibitor group and 521 (26%) in the alprostadil group. PDE5 inhibitors, compared with alprostadil treatment, were associated with lower mortality (hazard ratio: 0.88; 95% confidence interval: 0.79 to 0.98) and with similar associations for myocardial infarction, heart failure, cardiovascular mortality, and revascularization. When the quintiles (q) of PDE5 inhibitor prescriptions were compared, using q1 as the reference, patients in q3, q4, and q5 had lower all-cause mortality. Among alprostadil users, q5 users had lower all-cause mortality compared to q1.

(Shutterstock)
(Shutterstock)

The study shows that men who received PDE5 inhibitors lived longer and had a lower risk of a new heart attack, heart failure, balloon dilation and bypass surgery than those who received alprostadil.

Protection was dose dependent, so the more frequent the PDE5 inhibitor dose, the lower the risk. “This suggests that there is a causal relationship, but a registry study cannot answer that question. It is possible that those who received PDE5 inhibitors were healthier than those who took alprostadil and therefore had a lower risk. To determine if it is the drug that reduces risk, we would have to randomly assign patients to two groups, one taking PDE5 inhibitors and one not. The results we have now give us a very good reason to embark on such a study.”Holzmann explained.

PDE5 inhibitors are only available by prescription in Sweden. For this reason Holzmann hopes that men with coronary artery disease will discuss the matter with their GPs. “Impotence problems are common in older men and now our study also shows that PDE5 inhibitors can protect against heart attacks and prolong life”, He highlighted.

The study was conducted in collaboration with the Stockholm Obesity Center and the University of Milano-Bicocca. The Karolinska Institutet is dedicated to research across the entire field of medicine and today represents more than 40% of all academic medical research conducted in Sweden.

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