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Mortality Lower With PDE5i Treatment in Men With Stable CAD

MONDAY, April 12, 2021 -- For men with stable coronary artery disease, lower mortality is seen in association with phosphodiesterase 5 inhibitor (PDE5i) treatment versus alprostadil treatment, according to a study published in the March 30 issue of the Journal of the American College of Cardiology.

Daniel P. Andersson, M.D., Ph.D., from the Karolinska Institutet in Stockholm, and colleagues examined the association between treatment with PDE5i or alprostadil and outcomes among men with stable coronary artery disease during 2006 through 2013. Data were included for 16,548 men treated with PDE5i and 1,994 treated with alprostadil.

During a mean follow-up of 5.8 years, the researchers identified 2,261 and 521 deaths in the PDE5i and alprostadil groups, respectively (14 and 26 percent, respectively). Compared with alprostadil treatment, PDE5i treatment was associated with lower mortality (hazard ratio, 0.88), with similar associations seen for myocardial infarction, heart failure, cardiovascular mortality, and cardiac revascularization. Using quintile 1 (q1) of filled PDE5i prescriptions as reference, patients in q3, q4, and q5 had lower all-cause mortality. Among alprostadil users, compared with q1, q5 had lower all-cause mortality.

"PDE5i use is associated with a better prognosis in men with stable coronary artery disease," the authors write. "Randomized controlled trials are needed to determine if this is a causal effect because of the pharmacodynamic effects of PDE5i or merely a marker for better socioeconomic status and compliance, younger age, fewer comorbidities, and a healthier lifestyle."

One author disclosed financial ties to Idorsia.

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