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With a significant number of men experiencing erectile dysfunction in their middle to later years and the prevalence and ease of obtaining erectile dysfunction medication from their urologist or even online, many patients are concerned about the possible effects of these medications on the heart. Fortunately, data shows few significant adverse effects on the heart related to erectile dysfunction medications like Viagra and Cialis or their generic counterparts, sildenafil and Tadalafil.
Do ED Meds Have Any Effect on the Heart?
Understanding the effect of ED medications on a patient’s heart is important. Viagra, Cialis, and their generic forms are known as PDE-5 inhibitors. These medications work by relaxing the smooth muscles of the blood vessels, stimulating them to relax and dilate, thus allowing for increased blood flow. This function, however, is not limited to the arteries that supply the penis with blood. Every blood vessel throughout the body is also affected, which is why one of the possible side effects of the medication is flushing in the face, for example.
With that said, patients with known heart disease should speak to their doctors about whether their heart is strong enough for sexual activity, which can be strenuous. Also, patients who take nitrates for a heart condition should not take ED medications.
The Beneficial Effects of ED Medication on Heart Disease.
You would be right if you had an inkling that the dilation of blood vessel musculature may have a beneficial effect on heart disease. A 2023 study showed ED medications may be cardioprotective, though they should not be used for this purpose. In particular, patients taking these ED medications had:
- 39% lower mortality rate from cardiovascular disease
- 13% lower incidence of major cardiovascular events – heart attack, stroke, or heart failure
- 25% lower all-cause mortality rate
Despite being in the same class of drugs and generally having the same effect, there are differences between the two most prescribed ED medications. Viagra/sildenafil has a much shorter half-life, having effects for approximately 4 to 6 hours. On the other hand, Cialis/Tadalafil has a much longer impact, lasting for up to 36 hours. Cialis is also indicated at a low dose for combination ED and BPH treatment.
ED as a Possible Precursor to Coronary Heart Disease
Interestingly, the mechanism by which most ED occurs is the same as the beginnings of coronary heart disease – atherosclerosis. This is the buildup of plaque along the arterial walls, causing them to narrow and restricting blood flow. Because the arteries to feed the penis are so small in diameter, ED is one of the earliest manifestations of systemic atherosclerosis. Later, patients may experience peripheral artery disease and, eventually, coronary artery disease.
To this end, while online medication sellers make it easy and discreet to have a consultation and have the erectile dysfunction medications shipped directly to your home, it may be worth speaking to a urologist and cardiologist to understand more about the genesis of erectile dysfunction and whether any further testing is needed should heart disease be suspected.
The Bottom Line
Erectile dysfunction medications have few contraindications. However, men on nitrates for heart disease or chest pain and men who may not have sufficient heart strength for sex should not take these medications. On the other hand, some men may benefit from these medications, and studies have shown a reduction in cardiovascular and all-cause mortality by taking them.
Most importantly, patients should evaluate their risk of heart disease by considering their current medical history (weight, age, eating habits, smoking habits, etc.) and any family history of heart disease. Together, and in consultation with their medical team, we can evaluate the possibility that erectile dysfunction is a precursor to heart disease down the road.
We encourage you to contact our office to learn more and get screened for heart disease if you haven’t been already. When speaking to your cardiologist, be sure to mention any medication you may be taking, including erectile function pills. We are partners in this health journey, so don’t hesitate to be candid with us as we ensure your continued cardiovascular health.
1Robert A Kloner, Eric Stanek, Christopher L Crowe, Mukul Singhal, Rebecca S Pepe, Julia Bradsher, Raymond C Rosen, 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, The Journal of Sexual Medicine, Volume 20, Issue 1, January 2023, Pages 38–48, https://doi.org/10.1093/jsxmed/qdac005
