Therapeutics and Drugs Brief
Therapeutics and Drugs Brief
Effects of Sildenafil in Men with Severe Coronary Artery Disease
Source: Herrmann HC, et al. N Engl J Med 2000;342:1622-1626.
It is commonly overlooked that the development of sildenafil as an agent for erectile dysfunction (ED) evolved from its initial testing as a potential agent for angina. Many men who suffer ED also suffer other vascular disease, including coronary artery disease. The same risk factors that increase likelihood of ED (e.g., diabetes, hypertension, hyperlipidemia, and advanced age) are also associated with development of coronary artery disease. Since a number of serious cardiovascular events have occurred in men who use sildenafil, temporal association of sildenafil and cardiac events has prompted concern that sildenafil might be causally associated, although it remains uncertain whether acute cardiac events temporally related to sildenafil were due to the medication, the patient’s underlying cardiovascular disease status, stressful physical activity itself, or other factors. This study evaluated the systemic and coronary hemodynamic effects of sildenafil in men with severe coronary artery disease.
Study subjects were men (n = 14) with severe coronary artery stenosis (at least 70%) who were intended to undergo percutaneous coronary revascularization. Measurements were taken at the peak serum concentration of sildenafil (0.8-0.9 hrs post 100-mg dose), and compared with measurements in nonstenotic arteries for comparison.
Sildenafil produced less than 10% change in arterial pressure and had no effect on pulmonary wedge pressure, heart rate, or cardiac output. No adverse effects of sildenafil were detectable when measuring systemic, pulmonary, or coronary hemodynamics. These data support the position that, except for men on nitrates, sildenafil is safe for men with stable coronary artery disease, as proposed by the American College of Cardiology and the American Heart Association.
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