Erectile Dysfunction Drugs Are Safe After Heart Attacks

A study from Sweden has found that phosphodiesterase-5 (PDE-5) inhibitors, prescribed to men for erectile dysfunction, are good for the heart in more ways than we knew: those who took these drugs after having a heart attack had a much lower risk of dying or being hospitalized for heart failure than men who skipped them.

The study, being presented next week at the 66th Scientific Session of the American College of Cardiology in Washington, DC, finds that men prescribed drugs from this class—sold in the United States under brand names Viagra, Cialis, or Levitra—were 33% less likely to die from any cause than those who were not prescribed the drugs.

The study, previewed for reporters in a conference call earlier this week, evaluated data from 43,000 men for an average of 3.3 years after their first heart attack. No survival benefit was seen among men taking alprostadil, an erectile dysfunction therapy with a different mechanism of action.

Peter Andersson, MD, PhD, a postdoctoral researcher at the Karolinska Institutet in Stockholm and the study’s lead author, said the results are welcome news for men and their doctors who may have wondered about the safety of the drug class. “If you have an active sex life after a heart attack, it is probably safe to use PDE5 inhibitors,” Andersson said in a statement.

While the findings were described as a surprise, in a sense they aren’t: the first PDE-5 inhibitor, sildenafil (Viagra) was discovered by accident about 2 decades ago when investigators were trying to develop a new treatment for angina. But when a reporter asked Andersson if he could recommend PDE-5 inhibitors to treat heart failure, the doctor demurred, since the study was retrospective. “Not at this time,” he said.

Having an active sex life appears to reduce the risk of death, Andersson said, although he said a key limitation of the study was the fact that the data did not report the men’s marital status. More work is being done to zero in on the marital and socioeconomic status of those who benefit from taking the drug.

Of the large group studied, 7% were prescribed some type of erectile dysfunction drug. In this subset, 92% received a PDE-5 inhibitor and the remaining 8% received alprostadil. After adjusting for cardiovascular risk factors that included diabetes, heart failure, and stroke, those taking the PDE-5 inhibitors were less likely to die than those taking alprostadil or no drug at all. Filling more prescriptions appeared to increase the benefit, but Andersson said that the study was not large enough to confirm a dose-response relationship.

Andersson said erectile dysfunction is associated with increased heart disease risk in men who are otherwise healthy, and previous studies have linked the use of PDE-5 inhibitors with decreased blood pressure in the left ventricle. This reduces the level of work needed to pump blood and could explain their effect on men with heart failure.

Reference

Andersson DP, Lagerros YT, Grotta A, Bellocco R, Lehtihet M, Holzman MJ. Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction. Presented at the American College of Cardiology 66^th Scientific Session, Washington, DC, March 17-19.