Long-term effects of phosphodiesterase-5 inhibitors on cardiovascular outcomes and death: a systematic review and meta-analysis.

IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Stergios Soulaidopoulos, Dimitrios Terentes-Printzios, Nikolaos Ioakeimidis, Konstantinos P Tsioufis, Charalambos Vlachopoulos
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Abstract

Aims: Phosphodiesterase 5 inhibitors (PDE5i), which are widely used for the treatment of erectile dysfunction (ED), have been found to exhibit systemic vascular benefits by improving endothelial function. In this context, we sought to evaluate the effects of PDE5i on long-term cardiovascular outcomes and mortality.

Methods and results: A comprehensive search of electronic databases was conducted up to 30 May 2023. Cohort studies comparing PDE5i treatment at any dose with other ED treatment, placebo or no treatment and minimum follow-up duration of 6 months were considered eligible. The primary endpoints were: (1) major adverse cardiovascular events (MACE) and (2) all-cause mortality. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated. Sixteen studies were included (1 257 759 subjects-10.5% treated with PDE5i). The majority of patients (99.4%) were men [median age 61.5 years (range 30-72.8)]. The median follow-up duration was 4.3 years (range 6 months-7.5 years). PDE5i use was associated with a significant reduction in the composite of MACE (RR 0.78, 95% CI 0.69-0.89). Moreover, the analysis of pooled data from 13 studies, demonstrated that the use of PDE5i was associated with a significantly lower risk of all-cause mortality (RR 0.70, 95% CI 0.56-0.87).

Conclusion: The use of PDE5i primarily in men with or without known coronary artery disease was associated with a lower risk for cardiovascular events and overall mortality. This information underlines that PDE5i could provide clinical benefit beyond ED treatment and could instigate the conduction of further, large-scale randomized clinical trials.

磷酸二酯酶-5 抑制剂对心血管结果和死亡的长期影响:系统回顾与元分析》。
背景和目的:已被广泛用于治疗勃起功能障碍(ED)的磷酸二酯酶5抑制剂(PDE-5i)可通过改善内皮功能而对全身血管有益。在这种情况下,我们试图评估 PDE5i 对长期心血管后果和死亡率的影响:方法:对截至 2023 年 5 月 30 日的电子数据库进行了全面检索。将任何剂量的 PDE5i 治疗与其他 ED 治疗、安慰剂或无治疗进行比较且随访时间至少为 6 个月的队列研究均符合条件。主要终点为(1) 主要不良心血管事件 (MACE) 和 (2) 全因死亡率。计算了汇总风险比(RR)和 95% 置信区间(CI):共纳入 16 项研究(1,257,759 名受试者,10.5% 接受过 PDE5i 治疗)。大多数患者(99.4%)为男性[中位年龄 61.5 岁(30 - 72.8 岁)]。中位随访时间为 4.3 年(6 个月 - 7.5 年)。使用 PDE5i 可显著降低 MACE 的复合死亡率(RR 0.78,95% CI 0.69-0.89)。此外,对13项研究数据的汇总分析表明,使用PDE5i可显著降低全因死亡风险(RR 0.70,95% CI 0.56-0.87):结论:无论是否患有已知的冠状动脉疾病,男性使用 PDE5i 均可降低心血管事件和总死亡率风险。这些信息强调了PDE5i在治疗ED之外还能带来临床益处,因此可以进一步开展大规模随机临床试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
10.10
自引率
14.10%
发文量
65
期刊介绍: The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.
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