Observational studyJournal of the American College of Cardiology2021
Association of Phosphodiesterase-5 Inhibitors Versus Alprostadil With Survival in Men With Coronary Artery Disease.
Observational study in Journal of the American College of Cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Long-term effects of phosphodiesterase-5 inhibitors on cardiovascular outcomes and death: a systematic review and meta-analysis.European heart journal. Cardiovascular pharmacotherapy · 2024Pooled it
- From bedroom to boardroom: erectile dysfunction as a window into cardiovascular health.The Canadian journal of urology · 2026Review
- Systematic review and meta-analysis of risk factors for erectile dysfunction after stroke: a Mendelian randomization approach.Sexual medicine · 2026Article
- Erectile dysfunction and sexual health counselling after myocardial infarction treated with percutaneous coronary intervention.Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · 2026Article
- Erectile Dysfunction: A Comprehensive Review of Pathophysiology, Diagnosis and Contemporary Management.Medicina (Kaunas, Lithuania) · 2026Review
- Association of erectile dysfunction with all-cause and cardiovascular mortality in US men: findings from NHANES 2001-2004 with 16-year follow-up.International journal of impotence research · 2025Article
- Treatment With Phosphodiesterase 5 Inhibitors and Long-Term Outcomes in Patients Undergoing Coronary Angiography and Cardiac Catheterization.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025Article
- Phosphodiesterase 5 and its inhibitors with ischaemic heart disease: a Mendelian randomization analysis and a real-world study.European heart journal. Cardiovascular pharmacotherapy · 2025Article
- The association of tadalafil exposure with lower rates of major adverse cardiovascular events and mortality in a general population of men with erectile dysfunction.Clinical cardiology · 2024Observational
- Addressing the Missing Links in Cardiovascular Aging.Clinical interventions in aging · 2024Review
- Phosphodiesterase-5 Inhibitor Use in Robot Assisted Radical Prostatectomy Patients Is Associated with Reduced Risk of Death: A Propensity Score Matched Analysis of 1,058 Patients.The world journal of men's health · 2023Article
- Cardiac Effects of Phosphodiesterase-5 Inhibitors: Efficacy and Safety.Cardiovascular drugs and therapy · 2023Review
- Article
- Loss of soluble guanylyl cyclase in platelets contributes to atherosclerotic plaque formation and vascular inflammation.Nature cardiovascular research · 2022Article
- Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs.Nature reviews. Cardiology · 2022Review
- Anatomy, Pathophysiology, Molecular Mechanisms, and Clinical Management of Erectile Dysfunction in Patients Affected by Coronary Artery Disease: A Review.Biomedicines · 2021Review
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPhosphodiesterase 5 inhibitor (PDE5i) treatment is associated with reduced mortality compared with no treatment for erectile dysfunction after myocardial infarction (MI).
objectivesThis study sought to investigate the association between treatment with PDE5i or alprostadil and outcomes in men with stable coronary artery disease.
methodsAll Swedish men with a prior MI or revascularization who received PDE5i or alprostadil during 2006 through 2013 at >6 months after the event were included, using the Swedish Patient Register and the Swedish Prescribed Drug Register. Cox regression was used to estimate adjusted hazard ratios with 95% confidence intervals for all-cause mortality, MI, heart failure, cardiovascular mortality, noncardiovascular mortality, cardiac revascularization, peripheral arterial disease, and stroke in men treated with PDE5i versus alprostadil.
resultsThis study included 16,548 men treated with PDE5i and 1,994 treated with alprostadil. The mean follow-up was 5.8 years, with 2,261 deaths (14%) in the PDE5i group and 521 (26%) in the alprostadil group. PDE5i compared with alprostadil treatment was associated with lower mortality (hazard ratio: 0.88; 95% confidence interval: 0.79 to 0.98) and with similar associations for MI, heart failure, cardiovascular mortality, and revascularization. When quintiles (q) of filled PDE5i prescriptions were compared using q1 as reference, patients in q3, q4, and q5 had lower all-cause mortality. Among alprostadil users, those in q5 had a lower all-cause mortality compared to q1.
conclusionsIn men with stable coronary artery disease, treatment with PDE5i is associated with lower risks of death, MI, heart failure, and revascularization compared with alprostadil treatment. Although the decrease in all-cause mortality was PDE5i dose dependent, the data do not permit the inference of causality or any clinical benefits of PDE5i because of the observational study design.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.