PDE5-I use poses no excess cardiovascular, mortality risk in diabetic men with ED

The presence of erectile dysfunction (ED) does not appear to confer an increased risk of cardiovascular disease (CVD) and mortality in men with diabetes mellitus (DM), with comparable risk of adverse cardiovascular events among users and nonusers of phosphodiesterase-5 inhibitors (PDE5-Is), which are used to manage ED, according to a study.

Researchers conducted a systematic review and meta-analysis of observational cohort studies and randomized controlled trials (RCTs) that (1) assessed the association of PDE5-Is in patients with ED and DM and their risk of CVD and mortality and (2) determined whether ED conferred an excess risk of CVD and mortality in patients with vs without DM.

A search for relevant studies using multiple online databases yielded 18 unique studies that reported on the cardiovascular impact of ED in patients with and without DM. In the general population, ED was associated with increased risks of composite CVD/major adverse cardiovascular events (MACE; risk ratio [RR], 1.43, 95 percent confidence interval [CI], 1.31–1.55), all-cause mortality (RR, 1.47, 95 percent CI, 1.31–1.65), coronary heart disease (CHD; RR, 1.59, 95 percent CI, 1.39–1.82), and stroke (RR, 1.34, 95 percent CI, 1.15–1.56).

In the DM population, the respective estimates for the composite CVD/MACE, all-cause mortality, CHD, and stroke were comparable to those in the general population: 1.68 (95 percent CI, 1.15–2.45), 1.40 (95 percent CI, 0.90–2.18), 1.41 (95 percent CI, 1.24–1.61) and 1.32 (95 percent CI, 1.09–1.60). Interaction analyses confirmed that the risks were similar in both populations.

Data from six studies that reported the cardiovascular effects of PDE5-Is among patients with ED and DM were limited and inadequately underpowered. But pooled analysis suggested no significant differences in the risk of MACE (RR, 3.47, 95 percent CI, 0.17–69.19), CHD (RR, 1.31 (95 percent CI, 0.10–16.54), and all-cause mortality (RR, 0.35, 95 percent CI, 0.12–1.05).

Large-scale definitive studies are needed to validate the evidence.