The use of phosphodiesterase type 5 (PDE5) inhibitors was associated with a lower risk of death and cardiovascular events than alprostadil. Erectile dysfunction A stable man Coronary artery disease In a large Swedish registry study.
“Impotence is a major issue for the elderly male population, so we decided to consider this group,” said “whether PDE5 inhibitors can be used for people in this group who also suffer from cardiovascular disease.” Concerns remain. , MD, PhD, Karolinska Institute, Stockholm, Sweden said in an interview.
Previous team report Benefits of PDE5 Inhibitor Mortality in First Men Myocardial infarction (MI), British studies For men Type 2 diabetes.. However, both are comparing treatments with men who are not taking erectile dysfunction (ED) medications, he said, and the indications may have caused confounding.
Current analysis included 18,542 Swedish men with ED who underwent MI or coronary artery bypass surgery. Percutaneous coronary intervention, Of which 16,548 are PDE5 inhibitors (sildenafil, Tadalafil, Or vardenafil) and used local alprostadil in 1994. The average follow-up period for mortality was 5.8 years.
Alprostadil users are more likely to have previously had a stroke, diabetes, or active cancer, heart failure, Chronic obstructive pulmonary disease, Atrial fibrillation, Or Peripheral artery disease Use beta blockers, angiotensin converting enzyme inhibitors / angiotensin receptor blockers, thiazides, opioids, nitrates, or selective serotonin reuptake inhibitors. Users of PDE5 inhibitors were slightly younger and more likely to receive graduate education.
After managing these factors, the adjusted risks for the PDE5 inhibitor group were:
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Mortality from all causes is 12% lower (14% vs. 26%; hazard ratio) [HR], 0.88)
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19% lower in myocardial infarction (9.4% vs. 15%; HR, 0.81)
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25% lower in hospitalization for heart failure (1.0% vs 2.1%; HR, 0.75)
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31% lower for revascularization (13.1% vs 21%; HR, 0.69)
Studies have shown that the adjusted risk of stroke and peripheral arterial disease was similar between the two treatment groups. Release March 22 Journal of American Universities of Cardiovascular..
Mortality rates for cardiovascular death (5.1% vs. 10.6%) and non-cardiovascular death (6.9% vs. 12.2%) were about half in the PDE5 inhibitor group, but treatment was associated with cardiovascular death (6.9% vs. 12.2%). After adjusting only HR, 0.83), it was not significant. Non-cardiovascular death.
“Our first hypothesis was that cardiovascular mortality would decrease, but as we see, non-cardiovascular mortality also decreased, which we didn’t expect.” Said Anderson. “Both of these help reduce mortality, but I can’t say anything about causality yet.”
Age-based analysis showed that men aged 60 to 69 years treated with PDE5 inhibitors had lower mortality rates than their peers treated with alprostadil (adjusted HR, 0.81). However, this was not seen in men over the age of 70.
When researchers compared the quintiles of filled PDE5 inhibitor prescriptions, men in the third, fourth, and fifth quintiles were 16%, respectively, compared to men in the lowest quintile. It showed a 25% and 27% lower adjusted mortality risk. Men in the highest quintile with the alprostadil prescription had a lower risk of death than men in the lowest quintile.
“I need a randomized controlled trial, but if the doctor prescribing this drug determines that you have enough physical strength to get it, it’s probably good for you and you do it. You can take it and feel safe, “Anderson said.
Dr. Renchemers, MD, Friedrich Alexander University, Erlangen Nuremberg, Erlangen Germany, and Rome Rodionov, MD, Dresden University of Technology, Dresden, Germany, editorial “The association between PDE5i use and survival observed in men with coronary artery disease is interesting, but still insufficient to support changes in clinical practice.”
They are neither PDE5 inhibitors nor alprostadil, usually prescribed or taken for daily use, and only once-daily tadalafil with a 24-36 hour duration of action is the standard for continuous exposure. It points out that it meets. “This makes it difficult to attribute a strong association with mortality to the typical dosing pattern of PDE5i in men with ED.”
“In support of causality, in the Swedish cohort, High blood pressure, PDE5i may have improved survival by enhancing the clinical efficacy of antihypertensive drugs, “they write. Unfortunately, this interpretation can constitute the opposite causality. “
High cumulative exposure to PDE5 inhibitors may have simply identified healthier, more sexually active patients, as general deterioration in health is associated with decreased sexual desire and activity. Yes, Maas and Rodionov suggest.
The editors agree that randomized controlled trials are needed to address the issue of confounding and bias due to indications, but before starting such trials, “address one question first. Need to: Why hasn’t the pharmaceutical industry conducted this extensive trial yet? Indications for the last 20 years?
“This is puzzling given the ample data showing beneficial effects in the cardiovascular system and the fact that PDE5i was originally developed in the 1990s with the enormous potential market for coronary artery disease and hypertension in mind. “They add. “The answer may provide some important, and perhaps cool, insights.”
The study was conducted in collaboration with the Obesity Center in Stockholm, Sweden and the University of Milan Bicokka in Italy. Anderson was funded by a regional agreement on medical training and clinical research between the Stockholm County Council and the Karolinska Institute... Mars and Rodionov did not reveal the relevant financial relationship.
J Am Coll Cardiol.. 2021; 77; 1535-1550, 1551-1553. Full text, editorial
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