Phosphodiesterase-5 inhibitors (PDE5i) reduce the likelihood of major adverse cardiovascular events in men with both coronary artery disease (CAD) and erectile dysfunction (ED), according to study findings presented at the American Urological Association’s 2023 annual meeting in Chicago, Illinois.
In addition, investigators found that the cardiac benefit of PDE5i is more pronounced with tadalafil than sildenafil.
In a retrospective study of 41,287 men with CAD (but not pulmonary hypertension) and ED, Albert Ha, MD, of Columbia University’s Irving Medical Center in New York, New York, and colleagues found that men who took tadalafil and sildenafil had a significant 33% and 22% lower 5-year risk for heart failure, respectively, compared with men who received no PDE5i treatment after propensity-score matching. Tadalafil and sildenafil recipients had 25% and 12% lower 5-year risks for myocardial infarction and 41% and 35% lower 5-year risks for overall mortality, respectively.
Further, compared with sildenafil recipients, tadalafil-treated patients had significant 15%, 14%, and 15%, lower 5-year risks forheart failure, myocardial infarction, and overall mortality, respectively.
“I think our study is the first to tease out specific differences among individual PDE5i in relation to cardiac outcomes, with our preliminary results suggesting that tadalafil may be superior to other PDE5i like sildenafil in relation to heart failure, myocardial infarction, and mortality, ” Dr Ha said in an interview. “Since erectile dysfunction is a common harbinger for cardiac disease later in life, it is important for patients to understand what drugs may best address their medical issues, especially in a time when medical care may be siloed in different (and oftentimes disconnected) specialties. “
As for the greater cardiac benefit observed with tadalafil, Dr Ha said, “We speculate that this may be due to differences in pharmacokinetics, with tadalafil offering more specific inhibition of PDE5 enzymes with less cross reactivity, as well as a longer duration of efficacy. As such, this may promote medication compliance, particularly in patients with both ED and CAD. However, our results are preliminary, and as such, we cannot definitely conclude that clinicians should preferentially prescribe tadalafil until additional research is performed.”
The study population included 12,214 sildenafil users, 6751 tadalafil users, and 22,321 men who received no treatment. Dr Ha’s team performed propensity-score matching using baseline comorbidities of hypertension, ischemic heart disease, cerebral infarction, diabetes, and hyperlipidemia.
Ha H, Wayne G, Jacobs M, Kalogeropoulos A, Alukal J. Phosphodiesterase-5 inhibitor use and progression to heart failure in men with coronary artery disease and erectile dysfunction. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Presentation PD11-10.