This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (31)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in this journal  Topic Collections  • Men's Health  • Cardiovascular System  • Quality of Life  • Randomized Controlled Trial  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

A Prospective, Placebo-Controlled, Double-blind Crossover Trial

Linda J. Webster, MScN; Evangelos D. Michelakis, MD; Terry Davis, PhD; Stephen L. Archer, MD

Arch Intern Med. 2004;164:514-520.

Background  Erectile dysfunction (ED) is common in patients with congestive heart failure (CHF) and is often associated with symptoms of depression. Although sildenafil citrate, a phosphodiesterase 5 inhibitor, is effective in treating ED, its use is considered a relative contraindication in CHF. We hypothesized that sildenafil is a safe and effective treatment for ED in patients with New York Heart Association classes II and III CHF and that treatment of ED will improve symptoms of depression and enhance perceived of quality of life.

Methods  We studied 35 patients in a prospective, placebo-controlled, crossover trial for 12 weeks. Inclusion required a history of chronic ED and absence of ischemia (negative results from exercise stress test or nuclear perfusion scan) or nitrate use. The tolerability of sildenafil citrate was established by monitoring the ambulatory blood pressure for 4 hours after a single 50-mg dose. Improvement in ED, the primary end point, was assessed using the International Index of Erectile Function survey. The effect of improved erectile function on quality of life and mood was assessed using the Minnesota Living With Heart Failure Questionnaire, the Beck Depression Index, and the Center for Epidemiological Studies–Depression Scale.

Results  Sildenafil caused a mean ± SEM asymptomatic decrease in blood pressure of 6 ± 3 mm Hg, and no patient experienced symptomatic hypotension or other significant adverse effects. Sildenafil improved the International Index for Erectile Function (P<.001) and both sets of depression scores. The Living With Heart Failure Questionnaire index also improved with sildenafil (P = .02).

Conclusion  Sildenafil is a safe and effective treatment for ED in men with New York Heart Association classes II and III CHF and provides relief of depressive symptoms, explaining an improvement in the perception of quality of life.

From the Department of Medicine (Cardiology), University of Alberta, Edmonton. Ms Webster and Dr Michelakis contributed equally to this study. The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Efficacy and Safety of Sildenafil in Patients With Congestive Heart Failure
Nasser Mikhail
Arch Intern Med. 2004;164(18):2067-2068.
EXTRACT | FULL TEXT  

Use of Sildenafil Is Safe in Men With Congestive Heart Failure
Hans Mickley and Tina Svenstrup Poulsen
Arch Intern Med. 2004;164(18):2068.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction: A Clinical Practice Guideline From the American College of Physicians
Qaseem et al.
ANN INTERN MED 2009;151:639-649.
ABSTRACT | FULL TEXT  

Oral Phosphodiesterase-5 Inhibitors and Hormonal Treatments for Erectile Dysfunction: A Systematic Review and Meta-analysis
Tsertsvadze et al.
ANN INTERN MED 2009;151:650-661.
ABSTRACT | FULL TEXT  

Oral Phosphodiesterase-5 Inhibitors and Hormonal Treatments for Erectile Dysfunction: A Systematic Review and Meta-analysis
Tsertsvadze et al.
ANN INTERN MED 2009;0:0000605-200911030-00150v1-E-150.
ABSTRACT | FULL TEXT  

Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction: A Clinical Practice Guideline From the American College of Physicians
Qaseem et al.
ANN INTERN MED 2009;0:0000605-200911030-00151v1-E-151.
ABSTRACT | FULL TEXT  

Managing Erectile Dysfunction in Patients With Cardiovascular Diseases: The Efficacy and Safety of Phosphodiesterase-5 Inhibitors
Cheng and Berhane
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2009;3:201-211.
ABSTRACT  

CHAPTER 15c Erectile Dysfunction
Jackson
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

Sexual Activity and Chronic Heart Failure
Mandras et al.
Mayo Clin Proc. 2007;82:1203-1210.
ABSTRACT | FULL TEXT  

Phosphodiesterase Type 5 Is Highly Expressed in the Hypertrophied Human Right Ventricle, and Acute Inhibition of Phosphodiesterase Type 5 Improves Contractility
Nagendran et al.
Circulation 2007;116:238-248.
ABSTRACT | FULL TEXT  

The effects of intravenous sildenafil on hemodynamics and cardiac sympathetic activity in chronic human heart failure
Al-Hesayen et al.
Eur J Heart Fail 2006;8:864-868.
ABSTRACT | FULL TEXT  

Erectile Dysfunction in Heart Failure Patients
Schwarz et al.
J Am Coll Cardiol 2006;48:1111-1119.
ABSTRACT | FULL TEXT  

Efficacy and Safety of Sildenafil in Patients With Congestive Heart Failure
Mikhail
Arch Intern Med 2004;164:2067-2068.
FULL TEXT  

Use of Sildenafil Is Safe in Men With Congestive Heart Failure
Mickley and Poulsen
Arch Intern Med 2004;164:2068-2068.
FULL TEXT  

ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB
Evid. Based Med. 2004;9:131-131.
FULL TEXT  

JournalScan
Malik
Heart 2004;90:723-724.
FULL TEXT  

Is Sildenafil Safe and Effective for Men with Heart Failure?
Journal Watch Cardiology 2004;2004:3-3.
FULL TEXT