Men who take oral erectile dysfunction drugs after suffering a first heart attack are 33 percent less likely to die from any cause than those who don’t take these medications. These findings came recently from a study conducted by researchers at a prominent Swedish medical university.

Both heart disease and the vast majority of erectile dysfunction arise from vascular problems, so it is hardly surprising to find that men who have suffered a heart attack may also suffer from erection problems. And for ED caused by insufficient blood flow to the penis, the treatment of choice these days is one of a family of oral ED medications known collectively as PDE5 inhibitors. These drugs include Viagra (sildenafil), Levitra (vardenafil), Cialis (tadalafil), Staxyn (vardenafil), and Stendra (avanafil).

ED Treatment and Mortality Risk

Although the association between ED and an increased risk of cardiovascular disease has long been recognized, the link, if any, between ED treatment and mortality risk after a first heart attack had not been explored prior to this recent Swedish study.

Researchers from Stockholm’s Karolinska Institutet carried out a large-scale cohort study tracking the health outcomes of 43,145 Swedish men who had been hospitalized for a first heart attack between the years 2007 and 2013. The mean age of study participants was 64. During the mean 3.3 years of follow-up, 7.1 percent of these heart attack patients were prescribed either one of the PDE5 inhibitors or alprostadil, another vasodilator that is most commonly injected directly into the penis.

Mortality Risk Reduced

Karolinska researchers found that men who took one of the PDE5 inhibitors were 40 percent less likely to be hospitalized for heart failure and 33 percent less likely to die of any cause than heart patients who didn’t take a PDE5 inhibitor. No significant health improvements were noted in patients using alprostadil.

The findings from the Karolinska study were presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology in March 2017 and also published in the March 9, 2017, issue of “Heart,” the official journal of the British Cardiovascular Society.

Doctors caution some heart attack patients against strenuous activities, including sexual intercourse, in the wake of such an adverse cardiac episode. However, Daniel Peter Andersson, M.D., lead author of the Karolinska study, said that for those men able to resume an active sex life after a heart attack, “it is probably safe to use PDE5 inhibitors.”

Earlier UK Study Cited

The Swedish study follows by less than a year a U.K. study showing that men with type 2 diabetes who took PDE5 inhibitors appeared to lower their risk of mortality from all causes, including heart disease. The latter study, also published in “Heart,” drew its conclusions from tracking the health outcomes of nearly 6,000 men who had been diagnosed with type 2 diabetes before 2007.

Researchers found that 1,359 members of the study group had been prescribed PDE5 inhibitors. They also found that these ED drug users had a lower risk of all-cause mortality than non-users. This lower risk of mortality held true even after adjustments for age, smoking status, statin use, prior heart attack, prior stroke or ministroke, systolic blood pressure, and aspirin use.

Backs Italian Study’s Findings

These more recent studies tend to confirm findings from an earlier Italian study by research scientists from the Department of Experimental Medicine at Rome’s Sapienza University. That study, led by Andrea M. Isidori, an associate professor of endocrinology, found that continuing treatment with PDE5 inhibitors demonstrated cardioprotective effects.

Published in the October 2014 issue of “BMC Medicine,” the Italian study consisted of a meta-analysis of data from randomized, placebo-controlled trials (RCTs) designed to evaluate the efficacy and safety of PDE5 inhibitors on cardiac function and morphology.

The meta-analysis evaluated data from 24 RCTs in which 954 test subjects were given PDE5 inhibitors and 772 received placebo. Significant improvements in cardiac performance were noted in patients who were given PDE5 inhibitors.

How PDE5 Inhibitors Work

Originally introduced to treat erectile dysfunction, PDE5 inhibitors are so called because they temporarily disable an enzyme known as phosphodiesterase-5, which interferes with optimal blood flow to the penis. The PDE5 enzyme breaks down cyclic guanosine monophosphate, or cGMP, which plays a central role in erectile function. Synthesized as part of a secondary reaction when the brain sends a flood of nitric oxide coursing toward the pelvic region, cGMP signals the smooth muscle tissue lining artery walls to relax. As these muscles relax, arteries expand to carry the additional volume of blood needed to create and sustain an erection.

Men in robust vascular health don’t really need the added assist of PDE5 inhibitors to get and keep an erection. However, in men who have already suffered some degree of damage to their vascular systems, the likelihood of ED increases. By holding the PDE5 enzyme at bay, the ED drugs allow cGMP to perform unhampered, thus making it easier for users to achieve erection.

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