Erectile Dysfunction Meds Linked to Fewer Death and HF Hospitalizations After MI

Drugs commonly prescribed for erectile dysfunction (ED) are associated with a lower risk of death and hospitalization for heart failure among men who have had a first MI, according to new research scheduled to be presented at the American College of Cardiology (ACC) 2017 Scientific Session.

Speaking to the media in a web briefing hosted by the ACC, lead author Daniel Peter Andersson, MD, PhD (Karolinska Institute, Stockholm, Sweden), called the study “interesting and hypothesis generating” but stopped short of advocating the drugs for all men who have had a first MI, noting that cause and effect was not established.

Andersson’s study, which used the Swedish national database of health records that includes all hospitals in Sweden, tracked outcomes in 43,145 men hospitalized for a first MI from 2007 through 2013. All were less than 80 years of age and had no prior history of MI, cardiac revascularization, or ED. At a mean of 6.2 years following a first MI, approximately 7% had been prescribed an ED drug—either a PDE5 inhibitor (92%) or alprostadil (8%).

Positive Associations for Older Age, Dose

Mortality was 4% in the group who took PDE5 inhibitors like sildenafil and tadalafil versus 12% among men not on ED treatment, equating to a 33% decreased risk of all-cause mortality, the study’s primary endpoint. Those taking PDE5 inhibitors also had lower risk of the secondary endpoints of both cardiovascular and noncardiovascular death and a 40% lower risk of hospitalization for heart failure. However, taking a PDE5 inhibitor did not appear to be protective against risk of new MI or need for revascularization. In subgroup analysis, patients taking alprostadil for ED did not see the same reductions in death and hospitalization. The positive effects of PDE5 inhibitors were most pronounced in patients between 70 and 80 years of age.

Furthermore, the study authors found a dose-dependent relationship between the amount of PDE5 inhibitors dispensed and the degree of increased survival. In men with one, two to five, and more than five dispensed PDE5 prescriptions, adjusted risk of death was 27%, 45%, and 79% lower, respectively, compared with alprostadil.

Andersson urged caution in interpreting the results, and in particular attributing a causative role to the drugs: his group hypothesizes that PDE5 use may in fact be a marker for patients who are healthier overall, as evidenced by an active sex life and the fact that they request the medications.

Martha Gulati, MD (University of Arizona College of Medicine, Phoenix), who moderated the media briefing, agreed with that hypothesis and said it would be reasonable to assume that such patients are not on nitrates—PDE5 inhibitors are contraindicated in patients taking nitrates—and are less likely to have symptoms of angina. However, she expressed concern that the study’s message may be interpreted as implying “that these medications can be given safely to anybody who’s had a prior heart attack.”

Andersson agreed, noting that while “we cannot recommend at this stage that all patients with a previous myocardial infarction should have PDE5 inhibitors” to prevent a second event, the results are in line with other studies that have shown favorable effects of the drugs on hypertension, which could explain some of the impact on reductions in heart failure hospitalizations.

He suggested that physicians should do guideline-recommended risk assessment before prescribing ED drugs, adding that they can probably feel safe that if a patient 70 years of age or older asks about ED medication there likely is no reason not to prescribe it, given there are no contraindications.