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Cardiac Effects of Phosphodiesterase-5 Inhibitors: Efficacy and Safety

Sumon Roy1, Robert A Kloner2,3, Fadi N Salloum1

  • 1Pauley Heart Center, Virginia Commonwealth University Medical Center, McGuire VAMC, 1201 Broad Rock Boulevard, 111J, Richmond, VA, 23249, USA.

Cardiovascular Drugs and Therapy
|October 15, 2021
PubMed

Insights

Phosphodiesterase-5 (PDE5) inhibitors, used for erectile dysfunction, show potential cardioprotective effects in preclinical studies. However, clinical trials in cardiovascular disease patients have yielded mixed results, warranting further investigation into their efficacy.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Cardiovascular disease and erectile dysfunction frequently coexist, often linked by endothelial dysfunction.
  • Phosphodiesterase-5 (PDE5) inhibitors are widely prescribed for erectile dysfunction in patients with cardiovascular disease.
  • The cardiovascular effects of PDE5 inhibitors remain incompletely understood despite their common use.

Purpose of the Study:

  • To review the preclinical biological effects of PDE5 inhibitors in mediating cardioprotection.
  • To examine clinical trial data on PDE5 inhibition in patients with heart failure, coronary artery disease, and ventricular arrhythmias.
  • To discuss reasons for the mixed outcomes in translating preclinical findings to clinical efficacy.

Main Methods:

  • Review of preclinical studies on PDE5 inhibitors' effects on ischemia-reperfusion injury, pressure overload, and chemotoxicity.
  • Analysis of clinical trials investigating PDE5 inhibition in various cardiovascular conditions.
  • Discussion of potential discrepancies between preclinical and clinical findings.

Main Results:

  • Preclinical data suggest PDE5 inhibitors possess cardioprotective properties.
  • Clinical trials in heart failure, coronary artery disease, and arrhythmias have shown inconsistent results regarding efficacy.
  • No significant safety concerns have been reported with PDE5 inhibitor use in these patient populations.

Conclusions:

  • PDE5 inhibitors demonstrate promising preclinical cardioprotective effects.
  • Clinical translation of these benefits has been challenging, with mixed outcomes observed in cardiovascular trials.
  • Further research is needed to elucidate the efficacy and optimal application of PDE5 inhibitors in cardiovascular medicine.

Keywords:
CardioprotectionCardiovascular diseaseHeart failurePhosphodiesterase 5 inhibitor

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