Study finds erectile dysfunction medications associated with significant reductions in deaths, cardiovascular disease, dementia

A new study published in the American Journal of Medicine has found that medications commonly prescribed for erectile dysfunction-tadalafil (Cialis) and sildenafil (Viagra)-are associated with significant reductions in deaths, cardiovascular disease and dementia in middle-aged men. The study was conducted by researchers at the University of Texas Medical Branch and assessed outcomes over a three-year follow-up period.

The medications, known as PDE-5 inhibitors, were prescribed to patients for erectile dysfunction and, in the case of tadalafil, also for lower urinary tract symptoms often caused by an enlarged prostate gland.

"These medications, such as Cialis and Viagra, are believed to offer cardiovascular benefits through improved blood flow, lowering blood pressure, enhancing endothelial function, and providing anti-inflammatory effects," said Dr. Dietrich Jehle, Professor and Chair of UTMB's Sealy Department of Emergency Medicine and lead author of the study. "Additionally, the enabled sexual activity may contribute positively to mental health."

The study utilized the United States Collaborative Network, which includes data from over 50 million men within the TriNetX global database. For the study, researchers evaluated more than 500,000 men aged 40 or older diagnosed with erectile dysfunction between February 2004 and February 2021. Outcomes in men prescribed tadalafil or sildenafil were compared to those diagnosed with erectile dysfunction who did not receive the medications. Key findings include:

• Mortality: 34% reduction with tadalafil, 24% with sildenafil
• Heart Attack: 27% reduction with tadalafil, 17% with sildenafil
• Stroke: 34% reduction with tadalafil, 22% with sildenafil
• Venous Thromboembolism: 21% reduction with tadalafil, 20% with sildenafil
• Dementia: 32% reduction with tadalafil, 25% with sildenafil

Tadalafil, which remains active in the bloodstream longer than sildenafil, showed more substantial results across each category. Both drugs are PDE-5 inhibitors, which relax muscles and blood vessels.

The benefits of tadalafil for patients treated for lower urinary tract symptoms were even more pronounced. Among over 1 million men aged 40 or older diagnosed with lower urinary tract symptoms, those treated with tadalafil showed marked reductions in mortality (56%), heart attack (37%), stroke (35%), venous thromboembolism (32%), and dementia (55%) compared to patients who did not receive these medications for lower urinary tract symptoms.

"Cardiovascular disease remains the leading cause of death in the United States and is influenced by environmental, genetic, and lifestyle factors," Jehle said. "Both erectile dysfunction and lower urinary tract symptoms have been associated with an increased cardiovascular risk in men, highlighting the potential broader impact of PDE-5 inhibitors on public health."

The Food and Drug Administration has approved these medications for treating erectile dysfunction, pulmonary hypertension and lower urinary tract symptoms related to an enlarged prostate.

"PDE-5 inhibitors like Cialis and Viagra were originally developed for hypertension and angina, and their impact on erectile dysfunction was initially considered a secondary benefit," said Dr. Hani Jneid, UTMB's Chief of Cardiology and co-author of the study. "These findings could shift our approach to treating middle-aged and older men at risk for cardiovascular disease and dementia."

"The authors used a large-scale database of over 50 million men and employed propensity matching to control for confounding factors, which strengthens the validity of these significant results," said Dr. Jochen Reiser, UTMB President and CEO of the UTMB Health System.

The study's co-authors from UTMB included Raheed Sunesra, Dr. Hamza Uddin, Krishna K. Paul, Dr. Alejandro A. Joglar, Obadiah D. Michler, Dr. Thomas A. Blackwell, Dr. Diann Gaalema, and Dr. Salim Hayek.

https://doi.org/10.1016/j.amjmed.2024.10.039