Taking ED Drugs and Chest Pain Medications Poses Risk, Study Says

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Jan. 16, 2024 – A new study suggests that men who take drugs commonly prescribed for erectile dysfunction and nitrates for chest pain have an increased risk of heart failure, early death and other negative outcomes.

Drugs like Viagra and Cialis are commonly prescribed to treat erectile dysfunction, including for men with cardiovascular disease. But the study -- published Monday in the Journal of the American College of Cardiology -- says using such ED medications and nitrates could have an impact on mortality and morbidity rates.

The ED drugs in the brand-name medicines are phosphodiesterase-5 inhibitors, also known as PDE5i.

The use of PDE5i in people with ED and cardiovascular disease has been controversial because the drug and nitrates both induce low blood pressure, by working on endothelial cells in different ways, CNN reported.

“Endothelial cells line blood vessels and regulate exchanges between the blood and surrounding tissues,” CNN said. “Previous studies on the benefits or harms of simultaneous use have been mixed.”

Still, “physicians are seeing an increase of requests for erectile dysfunction drugs from men with cardiovascular diseases,” Andersson said.

“Our goal is to underscore the need for careful patient-centered consideration before prescribing PDE5i medication to men receiving nitrate treatment,” said the study’s senior author Daniel Peter Andersson, MD, at the Karolinska Institute in Stockholm, in a news release. “Furthermore, it justifies our efforts for continued research into the ambiguous effects of ED drugs on men with (cardiovascular disease).”

Participants in the study were 61,487 men from the National Swedish Patient Registry with a stable coronary artery disease and a history of myocardial infarction — a heart attack — or percutaneous coronary intervention between 2005 and 2013. 

About 56,000 had been treated with nitrates alone. About 5,700 were treated with both nitrates and PDE5i. The average follow-up time and age in the nitrate group was 5.7 years and around 70 years old, respectively; for the combination group it was 3.4 years and around 61 years old.

Men in the combination group had a slightly elevated risk of premature death from all causes. The risk for having undergone revascularization during the follow-up period was twice that of the nitrates-only group.