Erectile dysfunction medication may reduce death, HF hospitalization after MI

WASHINGTON — Men who received phosphodiesterase-5 inhibitors for the treatment erectile dysfunction had a significantly reduced risk for death and hospitalization for HF, according to a presentation at the American College of Cardiology Scientific Session.

"Only a few smaller studies have investigated [erectile dysfunction] in subjects with established CVD and to date, no large clinical studies have investigated the medical treatment for ED in men with previous MI,” Daniel Peter Andersson, MD, PhD, a postdoctoral researcher at Karolinska Institute in Stockholm, Sweden, said during a press briefing. “With this in mind, we want to investigate our hypothesis that treatment for [erectile dysfunction] is associated with an increased risk of death after first MI."

In a cohort study, researchers studied 43,145 Swedish men aged 18 to 80 years (mean, 64 years) with no prior MI or cardiac revascularization who were hospitalized for MI between January 2007 and December 2013.

Andersson and colleagues identified patients who received phosphodiesterase-5 inhibitors or alprostadil for erectile dysfunction and determined whether use of those medications was linked to MI, cardiac revascularization, HF or death.

Over a mean follow-up period of 3.3 years (141,739 person years), 7.1% of the cohort were given erectile dysfunction medication.

Compared with men not taking erectile dysfunction medication, men who received treatment had a 33% lower risk for mortality (adjusted HR = 0.67; 95% CI, 0.55-0.81) and a 40% lower risk for HF hospitalization (adjusted HR = 0.6; 95% CI 0.44-0.82).

Treatment with alprostadil was not associated with mortality.

Compared with men treated with alprostadil, the adjusted risk for death was lower in men treated with one prescription of phosphodiesterase-5 inhibitors (HR = 0.66; 95% CI, 0.38-1.15), two to five prescriptions (HR = 0.47; 95% CI, 0.26-0.87) and more than five prescriptions (HR = 0.19; 95% CI, 0.08-0.45).

A limitation of the study was that the effects of untreated erectile dysfunction or the effect of active sex without taking a drug for erectile dysfunction was not assessed by researchers, Andersson said during the press briefing.

Secondly, he said, socioeconomic status was not accounted for in the study.

Further research is being planned in a larger study which will include a larger amount of health records and information on marital status, educational level and income.

“We think that if you have an active sex life it’s probably an indicator of a healthy lifestyle, especially in the oldest quartile,” Andersson said in a press release. “From the perspective of a doctor, if a patient asks about erectile dysfunction drugs after [MI and] he has no contraindications for [phosphodiesterase-5] inhibitors, based on these results you can feel safe about prescribing it.” – by Dave Quaile

References:

Andersson DP, et al. Abstract 1166-344. Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C.

Andersson DP, et al. Heart. 2017;doi:10.1136/heartjnl-2016-310746.

Disclosure: Andersson reports no relevant financial disclosures.