This transcript has been edited for clarity.
Welcome Impact factor, Your weekly commentary on new medical research. Dr. F. Perry Wilson, Yale University School of Medicine.
Well, let’s not get in the way.This week Drugs for erectile dysfunction (ED) and long-term mortality,Thank you This study,It will be displayed in Journal of American Universities of Cardiovascular..
I think I’m immature about this — crack jokes, puns, stuff like that. Sorry for the disappointment, but this is a serious commentary on serious research.
Simply put, researchers found a sperm tract between men treated with phosphodiesterase-5 (PDE5) inhibitors such as Viagra and men treated with alprostadil.
I’m sorry. That’s it.
The background here is that it has long been established that ED is associated with poor cardiovascular outcomes. This is probably a substitute for vascular disease. Previous research The proportion of men with ED was found to be lower in men who received PDE5 inhibitors than in men who did not receive those drugs. However, a bias can occur when comparing men who have received an ED prescription with those who have not. Men who receive these prescriptions are healthy enough to have sexual activity, for example.
A better control group may be men with ED receiving another type of treatment, such as locally applied alprostadil (via injection, cream, or urethral suppository).
This study is from Sweden, the home of excellent pharmacological epidemiology. This is due to a national healthcare database that contains vast amounts of data on the health status, medications, and outcomes of everyone in the country.
Researchers have identified about 240,000 Swedish men who had previously had Myocardial infarction Or revascularization. About 20,000 of the group were taking ED medications. Most are PDE5 inhibitors, but alprostadil is sufficient for analysis.
Top-line results: Men taking PDE5 inhibitors of ED have MI, coronary blood circulation reconstruction, or heart failure Than those taking Alprostadil. In fact, during up to 15 years of follow-up, 14% of men died for some reason in the PDE5 group, compared to 26% in the alprostadil group.
Of course, when you see such a result, you immediately think about confounding. Who are these men using injections when tablets that achieve the same effect are on the market? Here you can see that the population was dramatically different. Men taking alprostadil are more likely to have diabetes, COPD, stroke, And active cancer, was basically ill in every way researchers could measure.
Adjusting all these factors dramatically diminished the observed benefits of PDE5 inhibitors, but could not eliminate them. This class was still associated with reduced cardiovascular and all-cause mortality.
My intestines [reaction] It is a conservative interpretation of such research. The dramatic differences in baseline characteristics between the two study groups suggest that there are quite dramatic unobserved differences that cannot be explained by statistics. The author did not have data on smoking status or obesity index, for example.
They did their best with what they had and showed here that there was something of a dose-response effect. More Prescriptions of PDE5 inhibitors have a lower risk than prescriptions with low filling. And, of course, this effect has biological relevance. Keep in mind that PDE5 was originally developed as an antihypertensive and antianginal drug. The impact on ED was either a happy accident or the result of a pharmaceutical company executive finding a magic lamp.
And there are others, uh, mechanism These drugs may improve long-term results. Without data on sexual activity, the pharmacological effects of these drugs on blood vessels cannot be separated from their lifestyle effects. Maybe these guys had to live more. Some studies —Yes, observation—suggests that more sexual activity is associated with longer lifespan.
Randomization is required to break them all apart. I’m sure this is okay for hiring. In the meantime, the data we suggest seems to suggest that the use of PDE5 inhibitors may yield more than negotiated. Call your doctor if your lifespan is extended by more than 4 hours.
F. Perry Wilson, MD, MSCE, is an associate professor of medicine and director of clinical and translational research accelerators at Yale University. His science communication work can be found at the Huffington Post, NPR, and here in Medscape.He tweets @fperrywilson Host a repository of his communication work at www.methodsman.com..
