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According to a new study, taking treatments for erectile dysfunction (Viagra, Cialis, Levitra, etc.) and nitrates increases the risk of premature death .
Erectile dysfunction is a common condition among men of a certain age and is a strong indicator of coronary heart disease. Phosphodiesterase type 5 (iPDE5) inhibitors constitute the standard treatment (sold under the names Viagra, Cialis, Levitra, etc.). Nitrates are medications commonly used to treat angina or chest pain.
Both can cause drops in blood pressure, and their use together is therefore contraindicated. But there is little real data on the implications of using both while the number of people prescribed both is increasing. A Swedish study takes stock.
A slightly higher risk of premature death
The study included 61,487 men with a history of myocardial infarction (MI) or percutaneous coronary intervention (PCI) who had received two nitrate prescriptions within six months. Having taken iPDE5 was defined as having received at least two prescriptions with these medications.
Of these men, 55,777 men were treated with nitrates and 5,710 were treated with both nitrates and iPDE5. The median follow-up duration for the entire cohort was 5.7 years among users of nitrates only and 3.4 years among users of both drugs. The group combining the two drugs was younger (61.2 years) than the group using only nitrates (70.3 years).
Result ? The group that took both the erectile dysfunction and chest pain medications had a slightly higher risk of premature death from all causes. However, the occurrence of immediate events (within 28 days of taking) is not more important. But overall, taking the two drugs simultaneously would notably drop blood pressure to dangerously low levels.
As for the risk of revascularization (restoration of blood supply by implanting an artery or vein upstream of the obstructed area to bypass the obstacle), it was twice as high within the group.combined” than in those taking only nitrates.
Confirmed side effects
Results, which did not surprise Dr. Howard C. Herrmann, John W. Bryfogle Professor of Cardiovascular Diseases at the University of Pennsylvania.
According to him, scientists “have known about the potential risk of low blood pressure with this combination of therapies for decades… (and) the coexistence of erectile dysfunction in many patients with coronary artery disease due to endothelial dysfunction of both diseases”.
The study has some limitations
While these initial results remain interesting, the study still has some limitations, believes Dr. Howard C. Herrmann.
“In particular, the fact of not knowing exactly how the patients took the two drugs: when, how often, what instructions were given to them in this regard, what types of nitrates and iPDE5 (with their different half-lives)“, he confided.
“Additionally, this type of analysis cannot prove causality and it may be that the need for PDE5i is a marker of more severe disease rather than the drug being the cause of more events.“.
Despite everything, caution is required because a drug interaction remains possible.
“This justifies our efforts to continue research into the ambiguous effects of erectile dysfunction drugs on men with cardiovascular disease“, concludes the study’s lead author, Dr. Daniel Peter Andersson.