Andersson Daniel P, Trolle Lagerros Ylva, Grotta Alessandra, Bellocco Rino, Lehtihet Mikael, Holzmann Martin J
Department of Medicine, Karolinska Institutet, Unit of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
Heart. 2017 Aug;103(16):1264-1270. doi: 10.1136/heartjnl-2016-310746. Epub 2017 Mar 9.
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.
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.
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.
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.
勃起功能障碍（ED）与健康男性心血管疾病风险增加相关。然而，首次心肌梗死（MI）后ED治疗与死亡或心血管结局之间的关联尚不清楚。
在一项瑞典全国队列研究中，纳入了2007年至2013年期间所有年龄<80岁、无既往MI或心脏血运重建且因MI住院的男性。将ED治疗定义为配发磷酸二酯酶-5抑制剂或前列地尔，并将其与死亡、MI、心脏血运重建或心力衰竭风险相关联。
纳入了43145名平均年龄64（±10）岁的男性，其中7.1%在平均3.3年（141739人年）的随访期间配发了ED药物。与未接受ED治疗的男性相比，接受治疗的男性死亡率降低33%（校正风险比[HR]0.67[95%置信区间（CI）0.55至-0.81]），心力衰竭住院风险降低40%（HR 0.60[95%CI 0.44至0.82]）。前列地尔治疗与死亡率之间无关联。与前列地尔治疗相比，接受1、2 - 5及>5次磷酸二酯酶-5抑制剂配发处方的男性校正死亡风险分别降低34%（HR 0.66[95%CI 0.38至1.15]）、53%（HR 0.47[95%CI 0.26至0.87]）和81%（HR 0.19[95%CI 0.08至0.45]）。
首次MI后ED治疗与死亡率降低及心力衰竭住院率降低相关。仅接受磷酸二酯酶-5抑制剂治疗的男性风险降低，且似乎呈剂量依赖性。
