ArticleSexual medicine2026
Daily tadalafil administration improves cardiac autonomic regulation in men with non-organic erectile dysfunction: a prospective heart rate variability study.
Article in Sexual medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
Background: Non-organic ED patients have cardiac autonomic dysfunction measurable by heart rate variability (HRV). Tadalafil reduces cardiovascular mortality, but exact mechanisms remain unclear. Aim: To evaluate daily tadalafil effects on cardiac autonomic regulation in non-organic ED and identify clinical predictors of HRV response. Methods: In this prospective study, 82 men with non-organic ED (mean age 46.8 ± 5.0 years) received tadalafil 5-10 mg daily. Assessment included International Index of Erectile Function-Erectile Function (IIEF-EF), echocardiography, laboratory tests, and 24-hour Holter ECG. HRV was analyzed via time-domain (standard deviation of NN intervals [SDNN], root mean square of successive differences [RMSSD]) and frequency-domain (low-frequency power [LF], high-frequency power [HF], LF/HF ratio) parameters. Post-treatment recordings were blindly evaluated. Early response to tadalafil was defined as achievement in the severity-adjusted Minimal Clinically Important Difference (MCID) in IIEF-EF or final IIEF-EF score ≥26. Outcomes: Primary: ΔSDNN. Secondary: ΔHF power, ΔLF/HF ratio. Results: IIEF-EF improved significantly (15 to 23, Clinical Implications: Daily tadalafil treatment may enhance parasympathetic modulation in men with non-organic ED regardless of clinical erectile improvement, suggesting a potential mechanism for its observed cardiovascular benefits. Strengths and Limitations: Strengths include rigorous, blinded Holter assessment. Limitations include the lack of a placebo control, short follow-up (28 days), and a small non-responder subgroup. Conclusion: Daily tadalafil enhanced parasympathetic modulation and reduced sympathovagal imbalance independently of erectile improvement.
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