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(Circulation. 2004;110:3149-3155.)
© 2004 American Heart Association, Inc.

New Drugs and Technologies

Cardiovascular Effects of the 3 Phosphodiesterase-5 Inhibitors Approved for the Treatment of Erectile Dysfunction

Robert A. Kloner, MD, PhD

From the Heart Institute, Good Samaritan Hospital, and the Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles.

Correspondence to Robert A. Kloner, MD, PhD, Heart Institute, Good Samaritan Hospital, 1225 Wilshire Blvd, Los Angeles, CA 90017. E-mail rkloner@goodsam.org

Received May 17, 2004; revision received June 22, 2004; accepted June 22, 2004.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Within the last year, 2 new phosphodiesterase-5 (PDE5) inhibitors have been approved by the US Food and Drug Administration (FDA) for the treatment of erectile dysfunction (ED). Currently, sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are on the market. These agents have been shown to be effective in a broad population of men with ED, including patients with vascular disease, coronary artery disease, hypertension, and diabetes.^1–5 Because the enzyme that they inhibit, PDE-5, is found in smooth muscle cells of the systemic arteries and veins throughout the body, these agents have mild vasodilator effects and thus, have the potential to impact the cardiovascular system.⁶ This fact is especially important for the patient with ED, because risk factors for ED include many of the same risk factors that are associated with coronary artery disease: lipid abnormalities, hypertension, smoking, diabetes, and lack of physical exercise.^7,8 Because erection is a vascular event, endothelial dysfunction may inhibit it.⁹ Endothelial dysfunction, an early component of atherosclerosis, is rarely confined to the arteries supplying blood to the penis but more likely occurs throughout the vascular bed. Kaiser et al¹⁰ studied 30 men with ED and observed that brachial artery flow–mediated vasodilation and nitroglycerin-mediated vasodilation were reduced in these patients compared with men without ED. Thus, ED may be an early marker of vascular disease.¹⁰ Patients with frank coronary artery disease, known to be associated with endothelial dysfunction, and frank atherosclerosis often have ED, as we recently observed in 1 study, in which three fourths of the . . . [Full Text of this Article]

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