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Viagra could one day treat heart disease

Are there other uses for the ‘wonder drug’?

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Erectile dysfunction drugs and the heart

Viagra type drugs (phosphodiesterase 5 inhibitors) were initially developed as a form of treatment for heart disease, in particular for angina or chest pain caused by reduced flow to the heart and hypertension. In early studies, the results when the drug (sildenafil or Viagra) was used for this purpose were not very positive but it was found that the drugs brought about stronger and more prolonged erections! This encouraged further research into this effect which has resulted in the PDE 5 inhibitor group of drugs that are taken for erectile dysfunction today.

There have been recent studies that may suggest that Viagra type drugs may be very important in the treatment of heart failure.

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The study

There was a study carried out in 2014 at the University of room whereby the effects of sildenafil (Viagra) were tested on humans to investigate how they may help some types of heart disease; the results indicated that the results of treating with sildenafil compared with the control group were favourable. It was concluded that PDE 5 inhibitors could be ‘reasonably offered to men with cardiac hypertrophy (enlarged heart) and in the early stages of heart failure’.

In May 2019 a further study was published by the University of Manchester. This involved another of the PDE 5 inhibitor drugs (Cialis or tadalafil) which were used to treat sheep whose hearts had gone into heart failure. The study was particularly aimed at seeing if the drug could be used to treat systolic heart failure. When this kind of heart failure happens it involves the heart’s left ventricle which is unable to contract as normal.

In this study, the team induced heart failure by using a pacemaker. When this happened they were given tadalafil in quantities comparable to those given to treat erectile dysfunction. Within three weeks the researchers were able to see improvement in heart function in the animals given the drug. Tadalafil improved the contraction of the heart muscle; it also restored the ability of the heart muscle to respond to epinephrine (adrenaline).

Whilst the studies have only been carried out on animals at this point, the older study in Rome would suggest that more research using this drug to treat humans will be very positive

How does the drug works?

When tadalafil is being used to treat erectile dysfunction it acts by expanding the blood vessels around the body. This allows the free passage of blood into the penis and facilitates an erection.

As we have explained, this group of drugs acts by inhibiting phosphodiesterase 5 which is an enzyme involved in determining how different types of body tissue interact with hormones, including the hormone epinephrine.

The research team at Manchester University noted that when tadalafil was given it caused the heart to begin responding to epinephrine again which in turn means that the heart muscle regains its ability to pump blood again.

The drug is only effective in treating systolic heart failure and there may be issues with it having interactions with other drugs a patient may be taking

What were the results?

Researchers found that treatment with tadalafil actually stopped the progression of heart failure and reversed some of the effects seen at the cellular level in heart failure. In addition, it restored the ability of the heart muscle to respond to epinephrine (adrenaline).

Conclusion

This latest study has demonstrated that PDE 5 inhibitors can have a direct effect on the cells in the heart.

What Is now needed is further studies on patients with heart failure so that we can establish that PDE 5 inhibitors have a positive effect on the outcome for these patients. It is noted that historically there have been drugs used that have been effective in improving the function of the heart but have not had any effect on changing the outcomes such as survival or incidence of hospital admissions.

The studies would also need to show that using these drugs is as good as or better than those currently used to treat heart failure and also ascertain which patients would most benefit from their use.

Heart failure is a very serious disease that affects approximately 26 million people worldwide; this represents a global pandemic that is increasing all the time. A drug that is showing early positive signs in the treatment of systolic heart failure is very exciting. Whilst more studies are still required, these development are very exciting and suggest a positive outcome in the future.

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