The impact of PDE5 inhibitors on cardiovascular outcomes

Abstract

Erectile dysfunction and cardiovascular disease share common underlying mechanisms, with the former being an early marker of cardiovascular risk. Phosphodiesterase-5 inhibitors, widely used as first-line therapy for erectile dysfunction, also exhibit systemic vasodilatory properties with potential cardiovascular implications. This systematic review evaluates their impact on cardiovascular outcomes in patients with coexisting erectile dysfunction and cardiovascular disease. A comprehensive analysis of 13 studies identified significant cardiovascular benefits, including reduced risks of myocardial infarction, heart failure, and overall mortality. The mechanisms underlying these effects include improved endothelial function, reduced systemic inflammation, and enhanced exercise capacity. Despite these benefits, neutral or adverse outcomes have been noted in specific conditions and populations, such as heart failure with preserved ejection fraction and post-stroke patients. These findings highlight the importance of patient-specific factors in determining the appropriateness of phosphodiesterase-5 inhibitors. These results underscore the potential of these therapies to provide cardioprotective effects while emphasizing the necessity for tailored treatment strategies to maximize benefits and mitigate risks in high-risk populations.