Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction

Heart. 2017 Aug;103(16):1264-1270. doi: 10.1136/heartjnl-2016-310746. Epub 2017 Mar 9.


Objective: Erectile dysfunction (ED) is associated with an increased risk of cardiovascular disease in healthy men. However, the association between treatment for ED and death or cardiovascular outcomes after a first myocardial infarction (MI) is unknown.

Methods: In a Swedish nationwide cohort study all men <80 years of age without prior MI, or cardiac revascularisation, hospitalised for MI during 2007-2013 were included. Treatment for ED, defined as dispensed phosphodiesterase-5 inhibitors or alprostadil, was related to risk of death, MI, cardiac revascularisation or heart failure.

Results: Forty-three thousand one hundred and forty-five men with mean age 64 (±10) years were included, of whom 7.1% had ED medication dispensed during a mean 3.3 years (141 739 person-years) of follow--up. Men with, compared with those without treatment for ED, had a 33% lower mortality (adjusted HR 0.67 (95%CI 0.55 to -0.81)), and 40% lower risk of hospitalisation for heart failure (HR 0.60 (95% CI 0.44 to 0.82)). There was no association between treatment with alprostadil and mortality. The adjusted risk of death in men with 1, 2-5 and >5 dispensed prescriptions of phosphodiesterase-5 inhibitors was reduced by 34% (HR 0.66 (95% CI 0.38 to 1.15), 53% (HR 0.47 (95% CI 0.26 to 0.87) and 81% (HR 0.19 (95% CI 0.08 to 0.45), respectively, when compared with alprostadil treatment.

Conclusions: Treatment for ED after a first MI was associated with a reduced mortality and heart failure hospitalisation. Only men treated with phosphodiesterase-5 inhibitors had a reduced risk, which appeared to be dose-dependent.

Keywords: Acute myocardial infarction; Coronary artery disease; Diseases; Epidemiology.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alprostadil / therapeutic use*
  • Cause of Death / trends
  • Dose-Response Relationship, Drug
  • Erectile Dysfunction / complications
  • Erectile Dysfunction / drug therapy*
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / etiology
  • Phosphodiesterase 5 Inhibitors / therapeutic use*
  • Prognosis
  • Retrospective Studies
  • Risk Assessment*
  • Risk Factors
  • Survival Rate / trends
  • Sweden / epidemiology
  • Young Adult


  • Phosphodiesterase 5 Inhibitors
  • Alprostadil