Viagra can prolong the life of men with coronary artery disease

Men with stable coronary artery disease who are taking Viagra due to impotence appear to live longer and are less likely to suffer a new heart attack, a study by the Karolinska Institutet in Sweden published in Journal of the American College of Cardiology reports.

Impotence can be an early warning sign of cardiovascular disease in healthy men and is treated locally with alprostadil, which dilates blood vessels to make the penis stiff, or with so-called PDE5 inhibitors, such as Viagra or Cialis, which are administered in tablet form orally before sex, inhibiting the enzyme phosphodiesterase5 (PDE5) in the penis to increase blood flow.

Because PDE5 inhibitors lower blood pressure, they were not recommended for men with coronary artery disease due to the risk of heart attack.

However, in 2017, Martin Holzmann and colleagues showed that men who had a heart attack tolerate the drug well and that it still prolongs life expectancy and protects against new heart attacks and heart failure.

In their new study, the researchers sought to compare the effect of inhibitors of alprostadil and PDE5 in men with stable coronary artery disease. Patients should have had a heart attack, balloon dilation, or coronary artery bypass graft surgery at least six months before starting treatment for erectile dysfunction.

“The risk of a new heart attack is greatest during the first six months, after which we consider coronary artery disease to be stable,” said lead author Martin Holzmann, associate professor in the Department of Medicine, Solna, Karolinska Institutet.

The registry study comprised 16,500 men treated with PDE5 inhibitors and just under 2,000 who received alprostadil. Data were collected from patient, drug and cause of death records.

The study shows that men who received PDE5 inhibitors lived longer and had a lower risk of a new heart attack, heart failure, balloon dilation and bypass surgery than those who received alprostadil. Protection was dose dependent, so the more frequent the dose of the PDE5 inhibitor, the lower the risk.

“This suggests that there is a causal relationship, but a registry study cannot answer that question,” says Holzmann. “It is possible that those who received PDE5 inhibitors were healthier than those taking alprostadil and therefore had a lower risk. To see if it is the drug that reduces the risk, we would need to randomly assign patients to two groups, one who takes PDE5 and one who doesn’t. The results we have now give us a very good reason to embark on this study. “

Since PDE5 inhibitors are available by prescription only in Sweden, they cannot be purchased over the counter, but Holzmann hopes that men with coronary artery disease will not shy away from discussing the matter with their doctor.

“Potency problems are common in older men and now our study also shows that PDE5 inhibitors can protect against heart attacks and prolong life,” he says.