Erectile dysfunction (ED) affects an estimated 30 million men in the United States (National Institutes of Health 2017). Medications are one of the most common treatments for ED, as they can help increase blood flow to the penis to help men achieve and maintain an erection. Recent evidence suggests that ED drugs may also have positive effects on cardiovascular health, which can benefit men with ED who are living with comorbid heart disease.
Here’s a closer look at how ED drugs work and how they may potentially reduce certain risks associated with heart disease.
Which Drugs Are Used to Treat ED?
The FDA has approved four drugs for the treatment of ED: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra). These drugs work by increasing blood flow to the penis and keeping sufficient blood supply inside the penile tissues so men can achieve and maintain erections during sexual activities.
ED drugs work effectively in about 70% of men who take them, according to Harvard Medical School. However, these medications may not work as efficiently or at all in men who have diabetes, prostate surgery, or heart disease.
Can ED Drugs Lower the Risk of Heart Disease?
Considering how ED drugs increase blood flow to the penis, it makes sense how they may also contribute to a reduced risk of heart disease. Initially, ED medications — which belong to a class of drugs called phosphodiesterase 5 (PDE-5) inhibitors — were being studied for the treatment of high blood pressure and angina, a type of chest pain. While investigating the effects of these drugs, researchers noticed that they also caused erections in study participants, which led to PDE-5 inhibitors being widely used to treat ED.
In a study published in The Journal of Sexual Medicine, researchers evaluated the effects of ED drugs on the incidence of major cardiovascular events, including stroke and heart failure. They learned that men who took ED drugs — specifically sildenafil, tadalafil, and vardenafil — were 25% less likely to die prematurely from heart-related events than men with ED who did not use these medications.
Additionally, the researchers learned that the men who took ED medications had a 39% lower death rate from heart disease, a 17% lower rate of heart failure, and a 13% lower rate of major adverse cardiovascular events. The researchers who led the study eventually concluded that ED drugs can have protective benefits against heart disease.
Who Should Use ED Drugs?
Any man who is experiencing ED may be an ideal candidate for PDE-5 inhibitors such as sildenafil and tadalafil, though your doctor can determine whether this treatment is right for you based on the root cause of your condition. In instances in which ED is caused by conditions such as depression, obesity, or the use of other medications, your doctor may recommend other treatments before PDE-5 inhibitors, such as losing excess weight or switching medications.
Indications for ED drugs include the following:
- Erectile dysfunction
- Pulmonary hypertension
- ED with premature ejaculation
- High-altitude sickness
- Penile rehabilitation after having prostate cancer surgery
- Urinary tract disorders
Some doctors may prescribe ED medications for other conditions, including:
- Heart failure
- Stroke
- Peripheral neuropathy
- Fertility problems
- Peripheral arterial disease (PAD)
- Diabetic neuropathy
What to Know When Using ED Drugs
Like any other medication or medical treatment, ED drugs do come with risks and side effects and may not work for everyone. Some of the most common side effects associated with ED drugs include:
- Mild headache
- Flushing
- Indigestion
- Vision changes
- Back pain
- Dizziness
- Low blood pressure
- Stuffy nose
Although ED drugs have shown promise for their ability to reduce the risk of heart problems, some people with a history of certain heart conditions should not use these medications. You should not use ED drugs if you meet the following criteria:
- You are using nitrates or nitroglycerin to treat a heart condition.
- You are using alpha-blockers to treat an enlarged prostate.
- You have congenital prolonged QT syndrome.
- You are using type 1A or type 3 antiarrhythmics.
- You have had a stroke, myocardial infarction, or life-threatening arrhythmia in the past six months.
- You have hypotension or hypertension at rest.
- You have a history of heart failure or unstable angina.
If you’re living with ED and/or heart disease or meet risk factors for heart disease, talk to your doctor about the possibility of using PDE-5 inhibitors. Your doctor can perform an evaluation to determine whether these medications can benefit you. They may also refer you to a specialist like a urologist who can work with you further.
Other treatments that may help improve symptoms of both ED and heart disease include exercising regularly, losing excess weight, improving your nutrition, and managing stress. Healthy lifestyle changes such as these may help improve your heart health, which, in turn, can improve ED.
Resource Links
“Definition & Facts for Erectile Dysfunction” via the National Institutes of Health
“Treatment for Erectile Dysfunction” via the National Institutes of Health
“Which drug for erectile dysfunction?” via Harvard Medical School
“PDE5 Inhibitors” via StatPearls Publishing
“Effect of phosphodiesterase type 5 inhibitors on major adverse cardiovascular events and overall mortality in a large nationwide cohort of men with erectile dysfunction and cardiovascular risk factors: A retrospective, observational study based on healthcare claims and national death index data” via The Journal of Sexual Medicine