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Everything you ever wanted to know about phosphodiesterase 5 inhibitors and the heart (but never dared ask): How do they work?

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Abstract

Introduction

Phosphodiesterase 5 inhibitors (PDE5i) were developed while investigating novel treatments for coronary artery disease, but their andrological side effects shifted their indication toward the management of erectile dysfunction. Although PDE5i are now also indicated for pulmonary arterial hypertension and there are mounting preclinical and clinical evidences about their potentially beneficial cardiac effects, their use remains controversial and the involved mechanisms remain unclear.

Materials and methods

This review aimed to analyze the effects of PDE5i administration in various animal and humans models of cardiovascular diseases.

Results

Animal studies have shown that PDE5i have protective effects in several models of cardiac disease. In humans, some studies showed that PDE5i improves microvascular and endothelial dysfunction and exerts positive effects in different samples of cardiovascular (CV) impairment. In contrast, other studies found no benefit (and no harm) in heart failure with preserved ejection fraction. The discrepancies in these findings are likely related to the fact that the mechanisms targeted by PDE5i in human disease are still poorly understood and the target population not yet identified. The mechanisms of actions herein reviewed suggest that hypertrophy, microvascular impairment, and inflammation, should be variably present for PDE5i to work. All these conditions frequently coexist in diabetes. A gender responsiveness has also been recently proposed.

Conclusions

Continuous PDE5 inhibition may exert cardioprotective effects, improving endothelial function and counteracting cardiac remodeling in some but not all conditions. A better patient selection could help to clarify the controversies on PDE5i use for CV disorders.

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Acknowledgments

This review was designed in the context of EnGioI Club (Italian Society of Endocrinology—SIE). The authors wish to thank the Italian Society of Endocrinology (SIE), Prof. A. Peri, and Prof. L. Bartalena for supporting the initiative.

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Authors and Affiliations

  1. Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    R. Pofi, D. Gianfrilli, C. Di Dato, M. A. Venneri & E. Giannetta

  2. Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    R. Badagliacca

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  1. R. Pofi
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  2. D. Gianfrilli
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  3. R. Badagliacca
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  4. C. Di Dato
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  5. M. A. Venneri
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  6. E. Giannetta
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Correspondence to E. Giannetta.

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Pofi, R., Gianfrilli, D., Badagliacca, R. et al. Everything you ever wanted to know about phosphodiesterase 5 inhibitors and the heart (but never dared ask): How do they work?. J Endocrinol Invest 39, 131–142 (2016). https://doi.org/10.1007/s40618-015-0339-y

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  • DOI: https://doi.org/10.1007/s40618-015-0339-y

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