Combo of PDE5i, Nitrates Increases Cardiovascular Morbidity, Mortality in Stable CAD

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Increased risk for cardiovascular morbidity and mortality seen with PDE5i use for erectile dysfunction in men with CAD

By Elana Gotkine HealthDay Reporter

TUESDAY, Jan. 16, 2024 (HealthDay News) — For men with stable coronary artery disease receiving nitrate medication, the use of phosphodiesterase-5 inhibitor (PDE5i) treatment for erectile dysfunction is associated with increased cardiovascular morbidity and mortality, according to a study published in the Jan. 23 issue of the Journal of the American College of Cardiology.

Ylva Trolle Lagerros, M.D., Ph.D., from the Karolinska Institutet in Stockholm, and colleagues used data from the Swedish Patient Register and the Prescribed Drug Register to examine the association between PDE5i treatment and cardiovascular outcomes in men with stable coronary artery disease treated with nitrate medication. Exposure was defined as two or more dispensed prescriptions of PDE5i.

The analysis included 55,777 men who were treated with nitrates and 5,710 men treated with nitrates and a PDE5i. The researchers found that combined use of PDE5i treatment with nitrates was associated with increased mortality, cardiovascular mortality, noncardiovascular mortality, myocardial infarction, heart failure, cardiac revascularization, and major cardiovascular events (hazard ratios, 1.39, 1.34, 1.40, 1.72, 1.67, 1.95, and 1.70, respectively).

“Our goal is to underscore the need for careful patient-centered consideration before prescribing PDE5i medication to men receiving nitrate treatment,” senior author Daniel Peter Andersson, M.D., Ph.D., from Stockholm University, said in a statement. “Furthermore, it justifies our efforts for continued research into the ambiguous effects of erectile dysfunction drugs on men with cardiovascular disease.”

One author disclosed ties to the pharmaceutical industry.

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