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Italian Study: Viagra May Be Risky for Men With Heart Failure


WebMD Health News

Sept. 25, 2001 -- We've all heard and laughed at Viagra jokes. Poking fun at "the little blue pill" is a favorite of late-night talk show hosts and regular folks alike. But for men with erectile dysfunction and their partners, the hope Viagra offers -- of restoring a healthy sex life -- is no laughing matter.

There have, however, been worrisome reports of health risks linked to the drug. Now Italian researchers say that taking Viagra can be deadly if users also have chronic heart failure, a condition where the heart is unable to pump healthy amounts of blood through the body.

Their new study, led by Gianfranco Picirillo, MD, of Medical Policlinic Umberto I in Rome, looked at the heart rhythms of 10 healthy men and 10 others with chronic heart failure after they took a standard dose of Viagra. While both groups experienced certain changes to their heart's normal electrical activity, those changes were more pronounced and were potentially more dangerous in the men with heart failure.

The scientists conclude that for men with heart failure, taking Viagra may result in abnormal heart rhythms, or arrhythmias, that could lead to sudden death. The risk is even more pronounced, they theorize, for patients who also take certain other drugs including certain antibiotics, antihistamines, antifungals, and cholesterol medications.

But other heart experts are not convinced there's anything to worry about.

"What we know about Viagra is clear," says Gary S. Francis, MD, director of the coronary intensive care unit at The Cleveland Clinic Foundation. "Physicians are well aware of it. The drug should not be taken with nitrates [nitroglycerin] because there's a risk of sudden, dangerously low blood pressure," he says. There has been no evidence, however, that heart failure patients in general should avoid Viagra, he tells WebMD.

Rony Shimony, MD, FACC, says that people with heart failure who have a weak heart and irregular heartbeats automatically have a higher death rate than healthy people.

"You're already in a higher risk group," says the attending cardiologist at Lenox Hill Hospital and at Cornell Columbia Presbyterian Medical Center, in New York City. He says that these sudden deaths can't necessarily be linked to Viagra and that the study "is not a reason to panic. Heart failure patients are at higher risk to start with," he tells WebMD.

What's more, says Shimony, "cardiac patients are clearly at increased risk from doing any form of exercise or taking any form of medication. You have to use common sense." No doctor would prescribe Viagra to a very ill patient, he tells WebMD, but if you're appropriately screened by your heart doctor, even if you have well-controlled heart failure, all evidence indicates that you will not drop dead.

According to Shimony, "the overall experience of the medical community has been that Viagra is a very safe drug" without long-term side effects. But because it is used only to enhance the quality of life, rather than prolong it, "when a doctor prescribes Viagra and something bad happens, that's when the drug comes under great scrutiny."

Francis does not completely dismiss the notion that something may be going on here, but significantly more work is needed to determine if the findings are important or not. Results from any test conducted on only 10 people "don't mean a whole lot," he says, but this one small study suggests is "that the use of Viagra in patients with heart failure has the potential to alter the electrical stability of the heart." And that change, he says, "may predispose them to arrhythmias, some of which may be fatal."

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