Most of the widespread knowledge about drugs like Viagra, Levitra and Cialis, which are based on variants of PDE-5 inhibitors, is focused on their ability to induce more vigorous and sustained erections in men suffering erectile dysfunction (ED). A quick search in Google for “PDE-5 harder longer” shows thirty-three million matches! But now research is beginning to show that a whole different context can relate to “PDE-5 longer”, which is how PDE-5 inhibitors can boost heart health, leading to longer life, not just longer erections.
The information comes from an in-depth analysis of data published in the Journal of Sexual Medicine, titled “Effect of phosphodiesterase type 5 inhibitors on major adverse cardiovascular events and overall mortality in a large nationwide cohort of men with erectile dysfunction and cardiovascular risk factors: A retrospective, observational study based on healthcare claims and national death index data”.
Wait! Before this scientific gobbledegook deters you from reading further, we can put it in much simpler terms, along the lines of “Do the popular treatments for men with ED have any effect on their heart health”?
The main features of the study:
- The objective was to determine the effect of PDE-5 inhibitors (the common ingredient of most ED pills) on the incidence of Major Adverse Cardiovascular Events (MACE) – heart attacks, strokes, heart failure, angina, etc.
- The data was drawn from a US claims database that yielded over seventy thousand men diagnosed with ED who had no prior history of MACE
- The study compared two large cohorts of men – those reporting ED who had received PDE-5 inhibitor medication, and a parallel control group of roughly the same average age who had not been medicated with PDE-5 despite having symptoms of ED
- The outcome of the study was that PDE-5 inhibitors may have cardioprotective effects
- The degree of protection was proportionate to the dosage.
Why was a new study of ED meds and heart health necessary?
Prior studies had looked at correlations between PDE-5 inhibitors and cardiovascular (CV) outcomes, but they primarily looked at the negative side. In other words, could taking ED medications increase the risk of any primary adverse CV outcomes, including CV death, myocardial infarction hospitalization, coronary revascularization, heart failure, stroke, and unstable angina pectoris?
Past studies aimed to find reductions in adverse CV outcomes. In most of them, the sample populations were mainly men with both ED and some pre-existing CV condition.
The unique aspect of the new study was that it excluded any men with a history of any identified CV conditions. So the focus is then much clearer.
Can PDE-5 inhibitors have a beneficial effect by reducing the risk of cardiovascular incidents in healthy men?
And the answer is … Yes!
- 13% reduction in the rate of major cardiovascular events such as stroke and heart attack
- 15% reduction in the need for procedures to open up blocked arteries (angioplasty, stenting, or bypass)
- 17% reduction in the rate of heart failure
- 22% reduction in the death rate due to unstable angina
- 39% lower death rate due to heart disease
It was also discovered that the reduction rate was directly related to the dosage of PDE-5 administered to the patients. The higher the dose, the greater the benefit.
Looking at how ED medication works, not what it does.
The statistics presented in the paper described what the analysis revealed. However, there was still the issue of explaining how a drug like PDE-5 inhibitor could produce effects like a boost heart health.
The main conclusion comes naturally. In treating ED, one of the primary functions of the drug is to block the PDE-5 enzyme and allow blood vessels to dilate. This permits increased blood volume to flow under higher pressure into the chambers of the penis, promoting erection. The same function allows PDE-5 inhibitors to be prescribed to treat pulmonary hypertension. By blocking the PDE-5 enzyme from working, PDE-5 inhibitors like Viagra (sildenafil) and Cialis (tadalafil) allow the pulmonary blood vessels to relax, which increases blood flow into the lungs, which lowers blood pressure.
Benefits coming from lower blood pressure include improving the overall health of the wall linings of blood vessels, taking some workload off the heart, and reducing the chance of developing atherosclerosis. Some other studies have suggested that PDE-5 inhibitors also have anti-platelet effects, preventing blood clots.
Where to from here with PDE-5 inhibitors and cardiac health?
It’s still fairly early, and further research is needed before a solid connection can be drawn between prescribing Viagra, Cialis, Levitra, or Stendra, the currently approved meds for treating ED, to prevent or treat cardiovascular disease.
However, there may be good reasons why a healthcare provider could elect to treat a patient with one of these drugs off-label. Doctors have the ultimate responsibility to treat their patients appropriately. If one of the ED meds presents the best alternative to other medications, then in that case, that choice can be fully justified.
Frequently Asked Questions
Which PDE does Viagra inhibit?
Viagra (sildenafil) inhibits a cyclic GMP phosphodiesterase (PDE) enzyme. Different PDEs are expressed in different tissues and have different physiological functions.
Does tadalafil affect the heart?
Tadalafil inhibits the PDE5 enzyme in the lung, allowing blood vessels to relax. This will increase blood supply into the lungs and reduce the workload on the heart.
How do phosphodiesterase inhibitors help with heart failure?
Phosphodiesterase inhibitors (PDIs) act by increasing intracellular cyclic AMP. This increases intracellular calcium concentration, leading to a positive inotropic effect.
Is Cialis good or bad for your heart?
Viagra, Cialis and other ED meds containing PDE-5 can boost heart health, cutting the risk of early death from heart disease by up to 40%. A new study has shown that men taking ED medication are less likely to experience heart failure, heart attack, or stroke.
What is the best ED medicine for heart patients?
Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil) may need several doses over time before they work correctly. Doctors may adjust the dose regularly and tend to prescribe these drugs six months after a heart attack, provided the condition is stable.