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Does sildenafil cause myocardial infarction or sudden cardiac death?
Kontaras K, Varnavas V, Kyriakides ZS.
2nd Department of Cardiology, Hellenic Red Cross General Hospital,
Athens, Greece.

Sildenafil was the first oral compound to be approved for the treatment
of erectile dysfunction. In this paper, we review the current knowledge
of the effects of sildenafil on myocardial infarction and sudden cardiac
death. The first factor we examine is the sexual activity itself. As
several studies have shown, the relative risk for an acute coronary
syndrome during intercourse is not very high. Several studies examining
the effects of sildenafil on mortality have been published during recent
years. The great majority of these studies found that sildenafil is not
an extra risk factor for an acute coronary syndrome or sudden cardiac
death. In 1997, the rate of myocardial infarction in men 55-64 years of
age was 1542 per 1 000 000 in the US. According to this, the expected
number of deaths as a result of myocardial infarction in patients 55-64
years of age receiving sildenafil, in the 24-hour period after use, from
late March 1997 to mid November 1998, should have been 52. Instead, the
number of reported deaths were only 15. One very optimistic finding was
that sildenafil not only does not increase mortality, but in fact
'preconditions' the heart and has a cardioprotective effect. Besides,
many studies have shown that sildenafil does not reduce the exercise
tolerance in men with known coronary artery disease. As far as BP is
concerned, the differences before and after the use of sildenafil are
not clinically significant. The only contraindications for sildenafil
are co-administration with alpha-adrenoceptor antagonists or with nitric
oxide donors. According to the most recent studies, isoform 5 of
phosphodiesterase has also been detected in the myocardium and controls
the soluble pool of 3', 5'-cyclic guanosine monophosphate (cGMP).
Sildenafil is very specific for cGMP but it may increase cyclic
adenosine monophosphate in the myocardium indirectly. This does not
occur with small therapeutic doses of the drug. There is some dispute
regarding the association of sildenafil with arrhythmias, where the
available evidence is not clear. However, there are suspicions that
sildenafil may cause sympathetic activation. The overall conclusion is
that sildenafil is a safe drug and that its appropriate use does not
seem to increase the risk for myocardial infarction or sudden cardiac
death.
PMID: 18303932 [PubMed - in process]

Bill