Tadalafil and Sildenafil Linked to Reduced Mortality, Cardiovascular Disease, and Dementia Risks: Study

"Tadalafil also provided similar benefits for patients experiencing lower urinary tract symptoms," Dietrich von Kuenssberg Jehle, Department of Emergency Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, US, and colleagues reported.

Erectile dysfunction and lower urinary tract symptoms, often resulting from conditions like benign prostatic hyperplasia and bladder neck obstructions, are common among men and are linked to a higher risk of cardiovascular disease. Phosphodiesterase-5 (PDE-5) inhibitors, including tadalafil and sildenafil, are commonly prescribed to treat erectile dysfunction and may also provide cardiovascular benefits due to their ability to promote vasodilation.

Against the above background, the researchers assessed the effects of PDE-5 inhibitors on all-cause mortality, cardiovascular disease, and dementia in middle-aged men with erectile dysfunction and lower urinary tract symptoms over a three-year follow-up period.

For this purpose, the researchers conducted a longitudinal study using data from 50 million US men in the TriNetX database. The study included men aged 40 or older who were prescribed tadalafil or sildenafil following a diagnosis of erectile dysfunction or tadalafil after a diagnosis of lower urinary tract symptoms between 2004 and 2021.

Three-year outcomes were assessed, including all-cause mortality, cardiovascular disease, and dementia, comparing men on PDE-5 inhibitors to those not using these medications. Propensity matching was employed to adjust for demographics and eight pre-existing conditions.

The following were the key findings of the study:

• The final cohort included 509,788 men with erectile dysfunction and 1,075,908 men with lower urinary tract symptoms.

• Both tadalafil and sildenafil were linked to significantly reduced risks of:

• All-cause mortality (RR: 0.66 for tadalafil, 0.76 for sildenafil)

 • Myocardial infarction (RR: 0.73 for tadalafil, 0.83 for sildenafil)

• Stroke (RR: 0.66 for tadalafil, 0.78 for sildenafil)

 • Venous thromboembolism (RR: 0.79 for tadalafil, 0.80 for sildenafil)

• Dementia (RR: 0.68 for tadalafil, 0.75 for sildenafil)

• Tadalafil provided more significant benefits than sildenafil in patients with erectile dysfunction.

• In men with lower urinary tract symptoms, tadalafil was similarly associated with reduced risks of mortality, cardiovascular disease, and dementia.

"The findings showed that the use of tadalafil and sildenafil in erectile dysfunction patients was associated with reduced risks of mortality, cardiovascular disease, and dementia, with tadalafil offering greater benefits. Additionally, tadalafil provided similar advantages for patients with lower urinary tract symptoms," the researchers concluded.

Reference:

Jehle, D. V. K., Sunesra, R., Uddin, H., Paul, K. K., Joglar, A. A., Michler, O. D., Blackwell, T. A., Gaalema, D., Hayek, S., & Jneid, H. (2024). Benefits of Tadalafil and Sildenafil on Mortality, Cardiovascular Disease, and Dementia. The American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2024.10.039