Drugs for impotence have reduced mortality after a heart attack
Oleg Lischuk, N+1
Swedish scientists have found that taking drugs from the group of phosphodiesterase inhibitors for the treatment of erectile dysfunction is associated with a reduction in mortality and the risk of severe heart failure after a myocardial infarction. The results are published in the journal Heart (Andersson et al., Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction).
Erectile dysfunction affects more than 20 percent of men aged 60 to 70 years. Impotence serves as an independent indicator of an increased risk of developing cardiovascular diseases. These conditions also have common risk factors, such as smoking, diabetes, obesity and a sedentary lifestyle. However, it was not known whether the treatment of erectile dysfunction could affect the outcomes of cardiac diseases.
To find out the possibility of such an influence, the staff of the Karolinska Institute in Stockholm analyzed the data of all men under the age of 80 who were hospitalized in Swedish clinics with the first myocardial infarction (and without previous interventions on heart vessels) from 2007 to 2013.
In total, the analysis included more than 43 thousand people (average age 64 years), of whom 7.1 percent regularly received drugs for impotence during an average of 3.3 years of follow-up (almost 142 thousand person-years in total). As a similar therapy, either phosphodiesterase type 5 inhibitors (iFDE5, such as sildenafil, vardenafil and tadalafil) or a prostaglandin E1 analog alprostadil were prescribed.
After the introduction of the correction for taking other medications and concomitant diseases, it turned out that during the follow–up period among men who received iFDE5, the overall mortality was 33 percent, and the frequency of hospitalizations for heart failure was 40 percent less than the rest. Taking alprostadil did not affect these indicators in any way.
The effect was dose-dependent: the adjusted risk of death among patients who received one, two to five and more than five prescriptions for iFDE5 was 34, 53 and 81 percent lower, respectively, than those taking alprostadil.
"The main result is that iFDE5 can be safely prescribed after a heart attack, and that they can even prolong life and protect against heart failure. The work also opens the way to randomized clinical trials of these drugs after a heart attack, in which women can also be included," explained one of the authors Martin Holzmann.
Scientists note that caution is necessary when interpreting the data obtained: people taking iFDE5 and leading an active sexual life may be in better physical shape, and the influence of other factors is not excluded. To clarify the effect of these drugs on the outcomes of cardiac diseases, the research team plans to conduct a prospective study with the participation of almost 140 thousand people suffering from stable angina, but who have not had a myocardial infarction or surgery on heart vessels.
IFDE5 is the most effective and popular medication for erectile dysfunction. Initially, the prototype of this group sildenafil was developed as a remedy for hypertension and coronary heart disease (it dilates blood vessels and prevents myocardial hypertrophy), but the effect was modest. Nevertheless, during the tests, the drug significantly improved the erection, which the participants liked and gave the developer a reason to register it for use according to this indication.
In addition to erectile dysfunction, iFDE5 (in particular, sildenafil) are used for symptomatic help with arterial hypertension. The possibility of their use for the prevention and treatment of altitude sickness is also being studied.
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