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Original research article
Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction
  1. Daniel P Andersson1,
  2. Ylva Trolle Lagerros2,
  3. Alessandra Grotta3,
  4. Rino Bellocco3,4,
  5. Mikael Lehtihet1,
  6. Martin J Holzmann5,6
  1. 1 Department of Medicine, Karolinska Institutet, Unit of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
  2. 2 Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
  3. 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  4. 4 Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
  5. 5 Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  6. 6 Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Martin J Holzmann; martin.holzmann{at}


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.

  • Acute myocardial infarction
  • Epidemiology
  • Coronary artery disease
  • Diseases

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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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