Erectile dysfunction (ED) is increasingly recognized as an early warning sign for cardiovascular disease (CVD), as both conditions share underlying mechanisms such as endothelial dysfunction and atherosclerosis. Since phosphodiesterase-5 (PDE5) inhibitors are the mainstay treatment for ED and also produce systemic vasodilatory effects, this review set out to examine whether their use has any influence on cardiovascular outcomes in patients with both ED and CVD. This systematic review looks at how PDE5 inhibitors may influence major cardiovascular events — including heart attacks, heart failure, strokes, and blood pressure — in men with both ED and CVD. The aim is to see whether these drugs provide any cardiovascular benefit beyond treating ED, and whether those effects could support a more tailored approach to managing patients with existing heart conditions.

A literature search was conducted in accordance with the PRISMA guidelines across multiple databases for studies looking at PH5 inhibitors and their associated cardiovascular outcomes (myocardial infarction, heart failure, stroke and blood pressure changes). Inclusion criteria included adult men suffering from ED and have a diagnosis of CVD. The data was retrieved and analyzed for 13 studies in which Cochrane Risk of Bias tool and Newcastle-Ottawa Scale assessed the quality of the studies.

Studies found that PDE5 inhibitors lower the risk of MI, heart failure and mortality, and thus have cardiovascular benefits. These outcomes were mainly due to improved endothelial function, reduced systemic inflammation, and enhanced capacity to exercise. Prescribing of the PDE5 inhibitors needs to be patient-specific, as per findings. In certain cases, like HFpEF with pulmonary hypertension, effects were neutral; in certain others, they were adverse, including stroke patients.

The findings suggest that PDE5 inhibitors may offer cardiovascular protection in certain patients with ED and coexisting CVD, likely through mechanisms such as improved vascular function and reduced inflammation. However, the variability in outcomes—ranging from benefit to neutral or even adverse effects in specific subgroups—highlights the importance of individualized treatment decisions. These results support a more cautious and tailored approach, especially in populations like those with HFpEF or a history of stroke.

The use of PDE5 inhibitors has surpassed the treatment of ED and also offered a cardioprotective effect in selected populations with CVD. A personalized treatment approach to maximize benefits and reduce risks in high-risk groups is essential.

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