Taking a combination of erectile dysfunction drugs and chest pain medications can raise mortality risk among men, according to new research from Sweden.
The peer-reviewed study, included in the latest issue of the Journal of the American College of Cardiology, investigated the impact of phosphodiesterase-5 inhibitor (PDE5i) drugs in men who have stable coronary artery disease (CAD) and take nitrate medication to manage their chest pain.
PDE5i drugs are commonly prescribed to treat erectile dysfunction (ED) and are sold under the popular brand names of Viagra, Levitra, and Cialis.
Stable CAD refers to a condition in which people with cardiovascular disease have not had a recent cardiac event.
Researchers concluded that the use of PDE5i drugs together with nitrate medication in men with stable CAD “may pose an increased hazard for cardiovascular morbidity and mortality.”
“Careful patient-centered consideration before prescribing PDE5is to patients with cardiovascular disease using nitrate medication is warranted,” it stated.
Prevalence of ED
Erectile dysfunction is estimated to affect roughly 30 million men in the United States.
It usually occurs in men who are over the age of 40; have risk factors for cardiovascular disease, diabetes, and obesity; uses recreational drugs, alcohol, and tobacco; have emotional or psychological issues; or suffer from pelvic trauma due to disease or injury.
Some men might suffer erectile dysfunction as a result of side effects due to taking certain antidepressants, sedatives, blood pressure medications, or other drugs.
The study looked at 61,487 Swedish men with a history of heart issues—myocardial infarction (MI) or percutaneous coronary intervention (PCI)—who had received nitrate prescriptions.
This included 55,777 individuals who only took nitrates and 5,710 people who received PDE5i drugs as well. These individuals were followed for a median period of 5.9 years.
“PDE5i treatment was associated with an increased relative hazard for all studied outcomes: all-cause, cardiovascular, and noncardiovascular death, MI, heart failure, revascularization, and MACE (major adverse cardiovascular event),” the study said.
“However, the number of events 28 days following dispensation of PDE5is were few, with lower incidence rates than in subjects taking nitrates only, indicating a low immediate risk for any event.”
Authors declared they received funding from the Stockholm County Council and the Strategic Research Program at Karolinska Institutet. However, none of the funders were involved in the design, preparation, review, or approval of the study.
In addition, an author declared that he received nonfinancial support from COVIS Pharma for another study. He is the site principal investigator for California-based biotech firm Ionis Pharmaceuticals and is also employed at Stockholm-based medical technology firm Werlabs.
ED Drug Risk
Daniel Peter Andersson, an associate professor at Karolinska Institutet in Stockholm and a senior author of the study, said that physicians are seeing an “increase of requests” from men with cardiovascular disease regarding erectile dysfunction (ED) drugs.
‘While there is a positive association of ED medication for men with CVD, patients taking nitrates may experience an increased risk of negative health outcomes,” he said in a Jan. 15 press release.
“Our goal is to underscore the need for careful patient-centered consideration before prescribing PDE5i medication to men receiving nitrate treatment.”
Glenn N. Levine from the Baylor College of Medicine said in the same release that PDE5i drugs are reasonably safe among patients with ischemic heart disease and mild angina who have decent exercise ability, provided they are not taking nitrate medication.
However, for individuals who do take nitrates, the use of PDE5i drugs is ill-advised, he said.
“ED and CAD are unfortunate, and all too common, bedfellows,” he said. “But, as with most relationships, assuming proper precautions and care, they can co-exist together for many years perhaps even a lifetime.”
The study admitted to certain limitations. Firstly, the subjects under study only comprised “high-risk individuals that already had experienced MI or revascularization.”
Moreover, these patients were prescribed nitrates and PDE5i twice. As such, the results “may not be entirely generalizable to the general population.”
Researchers also assessed medication usage by checking filled prescriptions. They did not know how compliant the individuals were in their medication habits.
Dr. Howard C. Herrmann, a cardiologist and professor of cardiovascular disease at the University of Pennsylvania, told CNN said that he was not surprised by the findings of the study.
Experts “have known about the potential risk of low blood pressure with this combination of therapies for decades … (and) about the co-existence of erectile dysfunction in many patients with CAD due to both diseases having endothelial dysfunction,” he said.
However, he was “most surprised by the high frequency (9 percent) of patients who were prescribed both medications.” Dr. Herrmann said that the study “should serve as an additional warning to physicians about the co-prescription of these medications.”
PDE5i drugs can cause other side effects, with the most common being headaches, issues with the digestive system, body aches and pain, flushes, changes in vision, and runny nose, according to Healthline.