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Phosphodiesterase type 5 (PDE5) inhibitor drugs used after myocardial infarction (MI) appeared safe, with better morbidity and mortality outcomes compared with nonusers in a population-based study from Sweden. Researchers chalked up the latter finding to a healthy-user effect.

Men who filled a prescription for one of these erectile dysfunction (ED) medications had a significant 33% reduced risk of dying of any cause during an average 3.3 years of follow-up after MI compared with those who didn't fill such a prescription, , of the Karolinska Institutet in Stockholm, reported at a press briefing ahead of a at the American College of Cardiology annual meeting in Washington, D.C.

The PDE5-inhibitor users had better survival rates than those taking alprostadil or no ED drugs after adjusting for cardiovascular risk factors including diabetes, heart failure, and stroke, and with an apparent dose-response relationship.

Men taking PDE5 inhibitors also showed a 40% reduction in risk of hospitalization for heart failure and significantly fewer major adverse cardiovascular events overall as well.

No such associations were found with the ED drug alprostadil (Muse), which works via vasodilation rather than by the PDE5 mechanism.

However, Andersson cautioned that users were healthier overall than men not prescribed the drugs and had fewer non-cardiovascular disease-related deaths, too, which he noted could have affected the results.

Prior studies have suggested that PDE5 inhibitors can have a small effect on hypertension and perhaps heart failure, but causality in the Swedish observational findings could not be determined, he noted.

The results should not be taken to suggest use of PDE5 inhibitors in secondary prevention after MI, but rather to support the safety for men who need it for erectile dysfunction, he added.

"At the moment I don't think we should change the recommendation regarding treatment," Andersson said. "However, our results suggest that if a patient about 70 years of age asks the doctor for ED medication and there are no contraindications for getting that, it's safe to prescribe the medication, and probably this patient has a decreased risk of death."

The moderator of the briefing, , chief of cardiology at the University of Arizona College of Medicine in Phoenix, agreed.

"We do worry about the use of these medications in patients who have already had a heart attack, so it's important knowing that it's relatively safe for them to use. Now, of course, I do think the patients are more likely to be healthier at baseline than the patients you wouldn't prescribe these medications for ... We would assume they would not be on nitrates, so they would be less likely to be having symptoms of angina."

The study included 43,145 men ages 80 and younger treated for a first MI from 2007 through 2013 in Sweden with data linked in from national drug and cause of death registers. But subgroup analysis suggested that the biggest effect was in men older than 70.

Andersson called the 7% rate of filled prescriptions for an ED drug (92% a PDE5 inhibitor, 8% alprostadil) representative.

The study did not have information on marital status, household income, or lifestyle factors.

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