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5MinuteConsult Journal Club

PDE5i for Erectile Dysfunction is Likely Safe in those with Ischemic Heart Disease


Ann Intern Med 2022 Apr 19. doi: 10.7326/M21-3445

Study Summary

Nationwide case study of Danish patients from 2000 to 2018 with ischemic heart disease (IHD) to determine if adverse cardiac risks (i.e., hypotension, worsening cardiac ischemia) occurred in those who had received prescriptions for nitrates and PDE5 inhibitors. Outcomes included:

Outcome 1: cardiac arrest, shock, myocardial infarction, ischemic stroke, or acute coronary arteriography

Outcome 2: syncope, angina pectoris, or drug-related adverse event.

During the study period, the prescription rate for PDE5 inhibitors in patients with IHD who were also prescribed nitrates increased from 0.9 prescriptions (95% CI, 0.5 to 1.2 prescriptions) per 100 persons per year to 19.5 prescriptions (CI, 18.0 to 21.1 prescriptions) in 2018.  When evaluated for adverse events, no statistically significant association was found between the co-prescription of nitrates with PDE5 inhibitors and the risk for either composite outcome.

Outcome 1: OR, 0.58 [CI, 0.28 to 1.13]

Outcome 2: OR, 0.73 [CI, 0.40 to 1.32].


In this post hoc evaluation from Denmark’s prescription database, having a prescription for a PDE5i and a nitrate in those with IHD did not increase the risk of serious adverse events.

Inducing cardiac ischemia is a common concern when we prescribe PDE5i agents in those with IHD, and we always counsel patients about the supposed risk. Some may even not prescribe them because of this risk. This study, while observational, should provide reasonable assurance that doing so is safe.

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