Objective Erectile dysfunction (ED) is associated with an increased risk of cardiovascular disease in healthy men. However, the association between treatment for ED and death or cardiovascular outcomes after a first myocardial infarction (MI) is unknown.
Methods In a Swedish nationwide cohort study all men <80 years of age without prior MI, or cardiac revascularisation, hospitalised for MI during 2007–2013 were included. Treatment for ED, defined as dispensed phosphodiesterase-5 inhibitors or alprostadil, was related to risk of death, MI, cardiac revascularisation or heart failure.
Results Forty-three thousand one hundred and forty-five men with mean age 64 (±10) years were included, of whom 7.1% had ED medication dispensed during a mean 3.3 years (141 739 person-years) of follow-up. Men with, compared with those without treatment for ED, had a 33% lower mortality (adjusted HR 0.67 (95%CI 0.55 to 0.81)), and 40% lower risk of hospitalisation for heart failure (HR 0.60 (95% CI 0.44 to 0.82)). There was no association between treatment with alprostadil and mortality. The adjusted risk of death in men with 1, 2–5 and >5 dispensed prescriptions of phosphodiesterase-5 inhibitors was reduced by 34% (HR 0.66 (95% CI 0.38 to 1.15), 53% (HR 0.47 (95% CI 0.26 to 0.87) and 81% (HR 0.19 (95% CI 0.08 to 0.45), respectively, when compared with alprostadil treatment.
Conclusions Treatment for ED after a first MI was associated with a reduced mortality and heart failure hospitalisation. Only men treated with phosphodiesterase-5 inhibitors had a reduced risk, which appeared to be dose-dependent.
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Contributor Study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content: all authors. Acquisition of data: MJH. Drafting of the manuscript: DPA and MJH. Statistical analysis: AG and RB.
Funding No specific funding was obtained for this study. MJH holds a research position funded by Swedish Heart-Lung Foundation (grant 20150603), YTL and DPA both had research positions funded by the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet.
Competing interests MJH received consultancy honoraria from Actelion and Pfizer
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice Since this paper was first published online the full text version has been updated. The results section in the abstract which stated ‘7.1% had ED medication dispensed during a mean 6.2 years (141 739 person-years) of follow-up.’ now states ‘a mean 3.3 years (141 739 person-years) of follow-up.’ This update was also made in two other sections of the article.
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