Viagra-Nitrate Combo Increases Mortality Risk in Heart Patients

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Viagra-Nitrate Combo Increases Mortality Risk in Heart Patients

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Viagra-Nitrate Combo Increases Mortality Risk in Heart Patients

JACC: Alert on the Danger of Viagra! KI Team Finds Combined Use of PDE5 Inhibitors and Nitrate Drugs Associated with 39% Increase in All-Cause Mortality Risk in Stable Coronary Heart Disease Patients.

When it comes to medication contraindications, people may immediately think of ibuprofen and acetaminophen, two analgesic drugs that should not be taken together.

But did you know that there are also medication contraindications between phosphodiesterase-5 inhibitors (PDE5i), commonly used to treat erectile dysfunction (ED), and nitrate drugs used to treat stable coronary heart disease?

The reason these two drugs are absolutely contraindicated is that they can dilate blood vessels through different pathways, and their combined use can lead to severe hypotension.

However, recently, a team led by Daniel Peter Andersson from the Karolinska Institute in Sweden found that the serious consequences of combining PDE5i and nitrate drugs go far beyond just hypotension!

They found that among 61,487 male stable coronary heart disease patients with a history of myocardial infarction or previous revascularization, simultaneous use of PDE5i and nitrate drugs was associated with a 39% increase in all-cause mortality risk (HR=1.39), a 72% increase in myocardial infarction risk (HR=1.72), a 67% increase in heart failure risk, and a 70% increase in major adverse cardiovascular events (MACE) risk.

The study was published in the Journal of the American College of Cardiology.

Due to the common risk factors and pathophysiological links between erectile dysfunction and cardiovascular disease, ED is very common in male patients with cardiovascular disease. Compared to the general male population, male patients with cardiovascular disease generally have a higher demand for ED treatment.

Currently, PDE5i is the most common ED treatment drug, and nitrate drugs are also common drugs for treating cardiovascular disease. In theory, these two drugs should not be used together, but in reality, studies have found that in some countries, the number of people using both drugs simultaneously is increasing year by year.

To observe whether the combination of these two drugs will affect cardiovascular disease, researchers included 61,487 male stable coronary heart disease adults who had experienced myocardial infarction or revascularization between 2006 and 2013 from the Swedish National Registry.

According to the Swedish Prescription Database, these patients had been prescribed nitrate drugs at least twice in the six months before enrollment (sublingual nitroglycerin, oral nitrate drugs alone, or in combination), and during this period, they had been prescribed PDE5i at least twice (sildenafil, tadalafil, vardenafil alone, or in combination). The primary endpoint of the study was the risk of all-cause mortality in patients receiving both treatments simultaneously.

The results showed that among the male patients included, 55,777 received only nitrate drug therapy, while 5,710 received both PDE5i and nitrate drug therapy. Overall, patients receiving both drugs were generally younger, with an average age of 61.2 years.

During a median follow-up period of 5.9 years, there were a total of 24,572 death cases, with 593 occurring in patients receiving combined treatment with both drugs. Multifactorial analysis showed that compared to those receiving only nitrate drug therapy, simultaneous use of both drugs was associated with a 39% increase in all-cause mortality risk in male stable coronary heart disease patients.

Furthermore, the researchers found that compared to those receiving only nitrate drug therapy, simultaneous use of both drugs was also associated with a 72% increase in myocardial infarction risk, a 67% increase in heart failure risk, a 34% increase in cardiovascular death risk, a 95% increase in coronary revascularization risk, and a 70% increase in MACE risk.

In conclusion, this study involving over 60,000 male stable coronary heart disease patients found that besides severe hypotension, simultaneous use of PDE5i and nitrate drugs is not only associated with an increased risk of all-cause mortality but also with an increased risk of various cardiovascular adverse events.

Given the increasing number of patients using both drugs simultaneously, the authors of this article believe that clinicians should fully consider the actual situation of patients before prescribing PDE5is to cardiovascular disease patients who are already using nitrate drugs.

At the same time, the authors also pointed out that the cohort involved in the current study is a high-risk cardiovascular event cohort, and the results may not be applicable to the general population. Further research is needed in the future to determine the causal relationship between simultaneous use of PDE5i and nitrate drugs and mortality risk, in order to provide better treatment advice for patients who develop angina after using PDE5i but cannot use nitrate drugs for emergency relief.

Viagra-Nitrate Combo Increases Mortality Risk in Heart Patients

Reference:

[1] Trolle Lagerros, Y, Grotta, A, Freyland, S. et al. Risk of Death in Patients With Coronary Artery Disease Taking Nitrates and Phosphodiesterase-5 Inhibitors. J Am Coll Cardiol. 2024 Jan, 83 (3) 417–426.

(source:internet, reference only)

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