UF cardiologists call for rigorous study of
Viagra and cardiovascular disease

By Melanie Fridl Ross

       University of Florida cardiologists say there is no solid scientific evidence that patients with cardiovascular disease face a higher risk of death when they take Viagra.

        Viagra, the tradename for the drug sildenafil citrate, is used to treat erectile dysfunction, which affects an estimated 150 million men worldwide. Many of these men have cardiovascular disease.

Viagra and nitroglycerin don't mix

         An outpouring of media attention ensued after a handful of patients with cardiovascular disease died after taking the popular medication. It's true that Viagra and nitroglycerin, commonly used to treat the chest pain known as angina, don't mix. Patients taking nitroglycerin shouldn't use Viagra because it can cause dangerous drops in blood pressure; likewise, patients who use Viagra should not take nitroglycerin for at least 24 hours. But there is no scientific proof Viagra is directly associated with death in cardiovascular disease patients, says Dr. Carl J. Pepine, professor and chief of cardiovascular medicine at UF's College of Medicine.

        Pepine and UF colleague Dr. C. Richard Conti led a symposium on "Managing erectile dysfunction in the cardiac patient" at the meeting of the 21st Congress of the European Society of Cardiology in Barcelona, Spain.

        "Some men with cardiovascular disease die, men with cardiovascular disease have a high frequency of erectile dysfunction, and some men with erectile dysfunction and cardiovascular disease take Viagra and die, too," Pepine said. "But there is no objective evidence to directly relate an increased frequency of death with Viagra use in these patients. Everything we have examined so far suggests that the frequency of death is about the same as in patients with heart disease who received a placebo."

        Pepine is calling for a controlled clinical trial comparing Viagra with placebo in about 5,000 heart disease patients, which he said would give scientists the answers they need. Earlier this year, Pepine and Conti co-authored a paper in a supplement to The American Journal of Cardiology that described an analysis of 11 studies of the drug in patients with erectile dysfunction and cardiovascular disease caused by reduced blood flow to the heart who were not taking nitrates; findings showed these patients tolerated the medication well.

Viagra may even ease certain problems

        What's more, it's possible that Viagra may even ease certain problems many patients with cardiovascular disease experience, such as depression.

         "The adverse outcomes of cardiovascular disease, such as heart attack or death, are due to a complex interplay of many risk factor conditions that aggravate the disease and its expression, including a host of psychological problems like depression and poor self-image as well as some physical factors," Pepine explained.

        In turn, Viagra's advantages may even play a role in reducing the overall risk of cardiovascular events such as heart attack or death, he hypothesized.

        "We believe Viagra may be safer than what is commonly perceived," he said.

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Thursday, May 20, 1999 University of Florida Health Science Center and Shands HealthCare. For more information, please call 352/392-2755 or e-mail: ebl@vpha.health.ufl.edu