In the treatment of erectile dysfunction in men with cardiovascular disease, phosphodiesterase-5 inhibitors, commonly referred to as PDE5i, are frequently prescribed.
However, a recent study involving over 60,000 men reveals that the concurrent use of this medication with nitrates, a common drug prescribed for chest pain, is associated with elevated risks of adverse health outcomes, including heart failure and premature mortality.
The findings of this study were published on Monday in the Journal of the American College of Cardiology.
Erectile dysfunction is prevalent among middle-aged and elderly men and serves as a significant indicator of the likelihood of developing coronary artery disease.
Nitrates, commonly employed for alleviating angina or chest pain, and medications for erectile dysfunction can both lead to reductions in blood pressure.
Consequently, their simultaneous use is contraindicated.
Despite this cautionary guidance, there exists limited empirical data regarding the practical consequences of concurrent administration, and the prevalence of prescriptions for both medications is on the rise.
The study involved 61,487 men with a history of myocardial infarction (MI) or percutaneous coronary intervention (PCI) who had received two nitrate prescriptions within six months.
Exposure criteria required a minimum of two filled prescriptions for any PDE5i medications.
Among this cohort, 55,777 men received nitrate treatment, and 5,710 received both nitrate and PDE5i treatment.
Health Dangers in PDE5i and Nitrate Combination
The study findings suggest that individuals concurrently using PDE5i treatment with nitrates face an elevated risk for all health outcomes in comparison to those solely using nitrates.
Notably, in individuals using both PDE5i and nitrates, there were few events observed within 28 days after the dispensing of PDE5is.
The incidence rates were lower than those in subjects exclusively using nitrates, signifying a low immediate risk for an event.
The study faces limitations, such as the inability to determine patient compliance and medication habits, and the incapacity to establish causality of death based on the available data.
While researchers assessed usage through filled prescriptions, details about patient compliance and specific medication habits remained undisclosed.
Additionally, the study’s participants, characterized by high-risk individuals with a history of myocardial infarction (MI) or revascularization, were prescribed nitrates at least twice and, against guideline recommendations, were also given PDE5i at least twice.
As a result, the findings may not be entirely generalizable to the broader general population.