Elevated Mortality Risk with Nitrates and Phosphodiesterase-5 Inhibitors in Patients with Coronary Artery Disease

A large nationwide registry study in Sweden confirms a hazard for adverse events with concomitant therapy.

Patients with cardiovascular disease are also at risk for erectile dysfunction, for which they may be prescribed a phosphodiesterase type 5 inhibitor (PDE5i). If these patients also require organic nitrates, the combination can lead to hypotension. In this nationwide registry study in Sweden, among 61,487 men with a previous myocardial infarction (MI) or percutaneous coronary intervention (PCI), researchers identified 5710 patients (9%) who had received at least 2 prescriptions for both a PDE5i and a nitrate medication and followed them for a median of 6 years.

Compared with patients taking only a nitrate medication, patients taking both nitrate and PDE5i medications had a higher all-cause mortality (adjusted hazard ratio, 1.4). Increased ha…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)