Combining ED and Chest Pain Drugs Raises Death Risk

Viagra and other erectile dysfunction drugs may increase the risk of death over time when combined with nitrate medication for chest pain.

Erectile dysfunction (ED) is a common condition in middle-aged and older men. About 52% of men aged 40 to 70 years experience some form of ED, according to a 1994 study; however, it can also affect younger men.

Medications for ED — phosphodiesterase type 5 inhibitors (PDE5i) sold under the names Viagra, Cialis, and others — are commonly prescribed to treat the condition in men with cardiovascular disease (CVD).

ED is a strong predictor of coronary artery disease (CAD), which is caused by plaque buildup in the wall of the arteries supplying blood to the heart. Over time, the buildup narrows the inside of the arteries, resulting in partial or total blockage of the blood flow. Angina, or chest pain, is often treated with nitrate medications.

PDE5i and nitrates can cause drops in blood pressure, so they are contraindicated for use together. However, despite the growing number of people using both medications, there is little real-world data on the implications.

A new study published in the Journal of the American College of Cardiology suggests that patients may be at higher risk for death and cardiovascular events when combining PDE5is and nitrates.

“Physicians are seeing an increase in requests for erectile dysfunction drugs from men with cardiovascular diseases,” Daniel Peter Andersson, MD, PhD, Associate Professor at Karolinska Institutet in Stockholm and senior author of the study, said in a statement. “While there is a positive association of ED medication for men with CVD, patients taking nitrates may experience an increased risk of negative health outcomes.”

Dangers of combining medications

The study examined the association between PDE5i treatment and cardiovascular outcomes in Swedish men with stable CAD who were taking nitrates.

Researchers looked at the data from 61,487 men with a history of myocardial infarction (MI) or percutaneous coronary intervention (PCI) who had received two nitrate prescriptions within six months.

Among these men, 55,777 were treated with nitrates, and 5,710 were treated with both nitrates and PDE5i. Those taking both medications were younger at 61.2 years compared to nitrate-only users who were 70.3 years old in general.

The study suggests that combining PDE5i and nitrates may increase the risk of all-cause mortality, cardiovascular and noncardiovascular mortality, MI, heart failure, cardiac revascularization, and major cardiovascular events compared to taking nitrates alone.

Our goal is to underscore the need for careful patient-centered consideration before prescribing PDE5i medication to men receiving nitrate treatment. Furthermore, it justifies our efforts for continued research into the ambiguous effects of ED drugs on men with CVD.

Daniel Peter Andersson, MD, PhD

The study, however, does not prove that combining these medications caused deaths; it just shows an association. Moreover, the data on patient compliance and medication habits was unavailable to the researchers.

Researchers note that Viagra and other PDE5is are safe in patients with ischemic heart disease and only mild angina with reasonable exercise ability. However, the use of PDE5i is not recommended in people undergoing chronic oral nitrate therapy.

What causes erectile dysfunction?

There are many causes of erectile dysfunction, which is defined as difficulty getting or maintaining a strong enough erection for sexual intercourse.

In some cases, ED may be caused by stress, anxiety, or excessive alcohol consumption. However, it is often a symptom of another health problem.

Besides diseases affecting the heart and arteries, ED is associated with the following conditions:

  • Type 2 diabetes
  • Chronic kidney disease
  • Multiple sclerosis
  • Peyronie’s disease
  • Injury from treatments for prostate cancer
  • Injury to the penis, spinal cord, prostate, bladder, or pelvis
  • Surgery for bladder cancer

While Viagra and other PDE5i are safe and effective treatments for erectile dysfunction, discuss your underlying conditions and the use of medications before taking them.


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