Phosphodiesterase type 5 inhibitor medications are a common treatment for erectile dysfunction in men with cardiovascular disease.
But taking this medication along with nitrates, a common medicine for chest pain, increases the risks of negative health outcomes such as heart failure and early death.
This is what a new study published on Monday (15) in the Journal of the American College of Cardiology points out.
“Our goal is to highlight the need for careful, patient-centered consideration before prescribing medications [como esse] for men receiving nitrate treatment,” said the study’s lead author, Dr. Daniel Peter Andersson, associate professor in the department of medicine at the Karolinska Institute in Stockholm, in a press release.
“Furthermore, it vindicates our efforts to continue research into the equivocal effects of erectile dysfunction medications on men with cardiovascular disease.”
A known but growing problem
The use of phosphodiesterase type 5 inhibitors in people with erectile dysfunction and cardiovascular disease has been controversial, since the medication and nitrates induce hypotension, or low blood pressure, by acting on endothelial cells in different ways.
Endothelial cells line blood vessels and regulate exchange between blood and surrounding tissues. Previous studies on the benefits or harms of concurrent use have been mixed.
But despite existing research and clinical guidelines discouraging concurrent use of the drugs, “doctors are seeing an increase in requests for ED medications from men with cardiovascular disease,” Andersson said.
The study included 61,487 men from the Swedish National Patient Registry with stable coronary artery disease and a history of myocardial infarction (a heart attack) or percutaneous coronary intervention between 2005 and 2013.
Percutaneous coronary intervention, also known as revascularization, is a nonsurgical procedure that treats blockages in a coronary artery by opening blocked or narrowed sections of the artery, restoring blood flow to the heart, according to Yale Medicine.
Participants also received two nitrate prescriptions (sublingual nitroglycerin or oral nitrates) within six months. The authors analyzed the effects of also having received at least two prescriptions for the erectile dysfunction drugs sildenafil, vardenafil or tadalafil.
Of these participants, 55,777 men were treated with nitrates alone, while 5,710 were treated with nitrates and phosphodiesterase type 5 inhibitors.
The mean follow-up time and age in the nitrate group were 5.7 years and about 70 years, respectively; for the combined group it was 3.4 years and about 61 years.
The combined group had a slightly higher risk of premature death from all causes. The risk of having undergone revascularization during the follow-up period was twice as high as the group that received only nitrates.
Dr. Howard C. Herrmann, the John W. Bryfogle Professor of Cardiovascular Disease at the University of Pennsylvania, was not surprised by the key findings.
Experts “have known for decades about the potential risk of low blood pressure with this combination of therapies (and) about the coexistence of erectile dysfunction in many patients with coronary artery disease due to both diseases having endothelial dysfunction,” Herrmann, who has not been involved in the study, as stated by email.
But he was “most surprised by the high frequency (9%) of patients who were prescribed both drugs,” added Herrmann, also chief of the interventional cardiology section at the Hospital of the University of Pennsylvania.
“It should serve as an additional warning to physicians about co-prescribing these medications.”
What patients should know
The study has weaknesses, including “not knowing exactly how patients took the two medications: when, how often, what instructions were given in this regard, what types of nitrates and phosphodiesterase type 5 inhibitors (with their different half- lives),” said Herrmann.
Half-life refers to how long it takes for the amount of a medicine’s active ingredient in your body to be reduced by half, or how long a medicine remains active.
“Furthermore, this type of analysis cannot prove causality and it may be that the need for phosphodiesterase type 5 inhibitors is a marker for more severe disease rather than the medication being the cause of more events,” Herrmann added. .
Having more definitive conclusions about the health effects of the drug combination would require “a randomized study in which patients received phosphodiesterase type 5 inhibitors and nitrates, or nitrates randomly,” said Dr. Dimitrios Terentes-Printzios, an interventional cardiologist in the first department of cardiology from the National and Kapodistrian Universities of Athens, Greece, via email. Terentes-Printzios was not involved in the study.
Generally, these medications should not be used together, Herrmann said.
But “patients with erectile dysfunction who wish to use a phosphodiesterase type 5 inhibitor should discuss with their doctor other treatment options for erectile dysfunction, as well as the need for nitrates (and alternatives) and be educated about when to take both medications. ,” said Herrmann.
“For example, a patient who takes a phosphodiesterase type 5 inhibitor, has sex, and then develops angina should not take nitrate medication to treat it, but should seek medical attention.”
