Combined Use of Erectile Dysfunction and Chest Pain Medication May Increase Risk of Death


A new study conducted in Sweden suggests that combining phosphodiesterase type 5 inhibitors (PDE5i), which are commonly used to treat erectile dysfunction (ED), with nitrate medication, a treatment for chest pain, may lead to higher risks of morbidity and mortality in patients. The study, published in the Journal of the American College of Cardiology, aims to provide a clearer understanding of the association between PDE5i treatment and cardiovascular outcomes in men with stable coronary artery disease (CAD) who are also being treated with nitrates.

Erectile dysfunction is a prevalent condition in middle-aged and older men and is considered a strong predictor of coronary artery disease. Nitrates are medications commonly prescribed to treat angina, or chest pain. Both PDE5i and nitrates can cause a drop in blood pressure, making their combination contraindicated. However, there is limited real-world data on the implications of using both drugs together, and the number of patients prescribed both medications is increasing.

The Swedish study, an update to previous research using the same national dataset, analyzed the association between PDE5i treatment and cardiovascular outcomes in 61,487 men with a history of myocardial infarction or percutaneous coronary intervention who had received two nitrate prescriptions within six months. Of these men, 55,777 were treated with nitrates alone, while 5,710 were treated with both nitrates and PDE5i. The median follow-up time was 5.7 years for those using nitrates alone and 3.4 years for those using both medications.

Using multivariable Cox proportional hazard regression, the researchers determined that the combined use of PDE5i and nitrates is associated with a higher risk for all health outcomes compared to taking nitrates alone. However, the incidence rates of events occurring within 28 days of dispensing the PDE5i were low, indicating a lower immediate risk of an event.

The study has its limitations, including the inability to know patient compliance with medication and prescribing habits. The population included high-risk individuals who had already experienced myocardial infarction or revascularization and were prescribed nitrates at least twice. Therefore, the results may not be entirely generalizable to the general population.

Understanding the effects of combining these treatments requires further investigation. However, the study emphasizes the need for careful consideration and evaluation of patients before prescribing PDE5i medications to men undergoing nitrate treatment.

In an accompanying editorial comment, it was noted that in patients with ischemic heart disease and mild angina, ED PDE5i medications are reasonably safe as long as the patient is not on chronic nitrate therapy. However, in those on chronic oral nitrate therapy, the use of PDE5i drugs is ill-advised and generally contraindicated.

The coexistence of ED and CAD is unfortunately common, but with proper precautions and care, they can coexist for many years, or even a lifetime, according to Glenn N. Levine, MD, from Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston.

This study reinforces the need for continued research into better understanding the effects of ED medications on men with cardiovascular disease and highlights the importance of patient-centered care and evaluation when considering the combination of these treatments.


  1. Source: Coherent Market Insights, Public sources, Desk research
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