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Title: Sildenafil Effective For Erectile Dysfunction In Some Men Diagnosed With Congestive Heart Failure

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Archives of Internal Medicine 2004;164:514-520.
03/10/2004 04:43:00 PM
By Elda Hauschildt

Sildenafil can be effective and safe for treating erectile dysfunction (ED) in men with New York Heart Association classes II and II congestive heart failure (CHF), research in Canada suggests. A 12-week, placebo-controlled, crossover trial with 35 patients who did not have myocardial ischaemia and who were not taking nitrates also indicates sildenafil provided relief of depressive symptoms, says Linda Webster, MScN and colleagues from the University of Alberta, Edmonton. The researchers say that sildenafil is a reasonable alternative to more invasive solutions to ED in patients with CHF, including penile implants and intracavernosal injections of vasodilators. Prevalence of ED in men aged from 40 to 70 years is 52%. The mechanism of normal erection appears to be compromised through the effects of aging and vascular disease. In fact, the association between vascular disease and ED is strong enough that ED has been proposed as a marker of cardiovascular disease. Patients with CHF have other predisposing factors for ED: use of multiple drugs and depression. "Depression, ED and cardiovascular disease have been proposed to form a mutually reinforcing triad," the investigators note. Patients with symptomatic hypotension, positive stress test results within the past year or a history of myocardial ischaemia, those on psychotropic therapy, those with significant valvular disease and those with a recent history of alcohol or drug abuse were excluded from the study. Participants were also screened to ensure they had the cardiovascular fitness required for sexual activity. Tolerance for sildenafil was established by monitoring ambulatory blood pressure for 4 hours after a single, 50-milligram dose of the drug was administered. The International Index of Erectile Function survey was used to measure improvements in ED at baseline, 6 weeks and 12 weeks. The effect of improved erectile function was assessed using the Minnesota Living with Heart Failure questionnaire, the Beck depression index and the Centre for Epidemiological Studies depression scale. Erectile function improved significantly at 4 weeks for participants who first received sildenafil, but returned to baseline levels at the crossover to placebo. Those who received placebo first showed no improvement until they crossed over to sildenafil therapy. Participants also showed improvements on the depression and the Living with Heart Failure indexes while taking the drug. None experienced symptomatic hypotension or other significant adverse effects.

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