Viagra can extend life for men with coronary artery disease

Men with persistent coronary artery disease who are on Viagra due to inability to live longer appear to be at lower risk of getting a new heart attack, a study from Karolinska Institutet in Sweden published in the Journal of the American College of Geology reports.

Infertility can be an early warning sign of cardiovascular disease in healthy men and is treated either topically with alprostadil, which dilates the blood vessels until the penis stiffens, or so-called PDE5 inhibitors, such as Viagra or Cialis, which are taken in oral tablet form before sex, inhibit the enzyme phosphodiesterase5 (PDE5) in the penis to increase blood flow.

Because PDE5 inhibitors reduce blood pressure, it has not been previously recommended for men with coronary artery disease because of the risk of heart attack.

However, in 2017 Martin Holzmann and his colleagues showed that men who have had a heart attack take the drug well and that it even extends life expectancy and protects against new infarctions and heart failure. .

In their new study, the researchers attempted to compare the effect of alprostadil and PDE5 inhibitors in men with stable coronary artery disease. Patients had either had infarction, balloon dilation or coronary artery bypass surgery at least six months prior to the start of treatment for erectile dysfunction.

“The risk of a new heart attack is greatest in the first six months, after which we believe the coronary artery disease is stable,” says lead author Martin Holzmann, associate professor at the Department of Medicine , Solna, Karolinska Institutet.

In the enrollment study 16,500 men were treated with PDE5 inhibitors and just under 2,000 received alprostadil. The data were collected from patient, drug and cause of death records.

The study shows that men who received PDE5 inhibitors lived longer and had a lower risk for new heart attack, heart failure, balloon dilation and bypass surgery than those who received alprostadil. The protection was dose-dependent, so the more frequent the dose of PDE5 inhibitor, the lower the risk.

“This suggests that there is a causal relationship, but a registration study cannot answer that question,” Holzmann says. “It is possible that those who received PDE5 inhibitors were healthier than those on alprostadil and therefore had a lower risk. To find out if it was the drug that reduced the risk, we had to randomly assign patients to two groups, one that gives PDE5 and one that does not. The results we have now give us a good reason to start such a study. “

Because PDE5 protectors are only available by prescription in Sweden, they cannot be purchased over-the-counter, but Holzmann hopes men with coronary artery disease will not refuse to deal with it. issue with their doctor.

“Potassium problems are common in older men and now our study also shows that PDE5 inhibitors may protect against heart attack and prolong life,” he says.

###

The study was conducted in collaboration with the Obesity Center in Stockholm and the University of Milano-Bicocca. Martin Holzmann receives funding from the Swedish Heart and Lung Foundation and the Stockholm Region. Daniel Andersson has received a grant through a collaboration between the Stockholm Region and Karolinska Institutet. Martin Holzmann has previously received consultancy fees from the pharmaceutical company Idorsia. No other conflicts of interest were reported.

Published: “Association of Phosphodiesterase-5 vs Alprostadil with Survival Inhibitors in Men with Coronary Artery Disease”. Daniel P Andersson, Laura Landucci, Ylva Trolle Lagerros, Alessandra Grotta, Rino Bellocco, Mikael Lehtihet, Martin J Holzmann. Journal of the American College of Geology, online March 22, 2021, doi: 10.1016 / j.jacc.2021.01.045