Taking erectile dysfunction and chest pain drugs linked with early death risk

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For male erectile dysfunction associated with cardiovascular diseaseED drugs phosphodiesterase-5 inhibitors (also known as PDE5i) are a common treatment.

But a new study of more than 60,000 men taking the drug along with nitrates, a common drug. for chest painwhich increases the risk of negative health outcomes such as heart failure and early death. Research published on Monday Published in the Journal of the American College of Cardiology.

“Our goal is to highlight the need for careful patient-centered consideration before prescribing PDE5i drugs to men on nitrate therapy,” said lead author of the study and director of Karolinska Research in Stockholm. said Dr. Daniel Peter Anderson, associate professor of medicine. , in news release. “Furthermore, this justifies our continued efforts to study the ambiguous effects of ED drugs on men with (cardiovascular disease).”

PDE5i is controversial for use in people with both ED and cardiovascular disease. This is because PDE5i and nitrate act on endothelial cells in different ways to induce hypotension.endothelial cells line blood vessels Regulates exchange between blood and surrounding tissues. Previous research on the benefits or harms of concurrent use is mixed.

However, despite such existing research, Demotivating clinical guidelines With the simultaneous use of these drugs, Anderson said, “physicians are seeing an increase in requests for erectile dysfunction drugs from men with cardiovascular disease.”

The study involved 61,487 men from the Swedish National Patient Registry with stable coronary artery disease and a history of myocardial infarction (heart attack) or percutaneous coronary intervention between 2005 and 2013. Percutaneous coronary intervention, also called revascularization, is a non-surgical procedure. Treats blockages in the coronary arteries by opening the blocked or narrowed part of the artery and restoring blood flow to the heart. According to Yale Medicine.

Participants also had received prescriptions for two types of nitrates within the past six months: sublingual nitroglycerin or oral nitrates. The authors looked at the impact of also receiving at least two filled prescriptions for the PDE5i drugs sildenafil, vardenafil, or tadalafil.

Of these participants, 55,777 men were treated with nitrates alone and 5,710 were treated with both nitrates and PDE5i. The mean follow-up period and mean age in the nitrate group were 5.7 years and approximately 70 years, respectively. In the combination group it was 3.4 years old, approximately 61 years old.

The combination group had a slightly higher risk of early death from any cause. The risk of undergoing revascularization during follow-up was twice that of the nitrate-only group.

Dr. Howard C. Herman, the John W. Breyfogle Professor of Cardiovascular Disease at the University of Pennsylvania, was not surprised by the major findings.

The experts said, “We have known for decades about the potential risk of hypotension with this treatment combination…[and]the potential risk of erectile dysfunction in many CAD patients due to both diseases with endothelial dysfunction. We also knew about co-existence,” Herman said. He said in an email that he was not involved in the study.

But what surprised him most was the high frequency (9%) of patients who were prescribed both drugs,” added Herman, who is also chief of interventional cardiology at the Hospital of the University of Pennsylvania. . “This should serve as an additional warning to physicians about prescribing these drugs together.”

The study had weaknesses, including “how patients took both drugs, the timing, how often, what instructions were given in this regard, and how the nitrates (which have different half-lives) and These include things we don't know exactly, such as the type of PDE5i,” Herrmann said. .half life refers to how long Until the amount of the active ingredient of the drug in the body is reduced by half, or the effective period of the drug is reduced.

“Furthermore, this type of analysis cannot prove causation, and the need for PDE5i (such as ED) may be a marker of a more severe disease, rather than the drug being the cause of further events.” “There is,” Herman added.

“Randomized studies in which patients are randomly given PDE5 inhibitors and nitrates, or nitrates,” will be needed to draw clearer conclusions about the health effects of drug combinations, said Dr. said Dr. Dimitrios Terentes Prinzios, an interventional cardiologist. Email National Kapodistrian University of Athens, Greece. Terentes Prinzios was not involved in this study.

In general, these drugs should not be used together, Herman says.

However, “ED patients who wish to use PDE5i should discuss not only the need for nitrates (and alternative medications) but also other ED treatments with their doctor and receive instructions on when to take both medications.” “There is,” Herman said. “For example, a patient who takes a PDE5i and develops angina after having sex should not take nitrate drugs for treatment and should see a doctor.”