研究者ら、強心剤と硝酸薬の併用処方に注意を促す(Researchers urge caution in co-prescribing potency drugs and nitrates)

2024-01-172024-01-18

2024-01-15 カロリンスカ研究所(KI)

◆スウェーデンの研究によれば、硝酸塩とバイアグラなどの強壮剤を同時に処方すると、死亡リスクが35-40%増加し、心臓発作・心不全のリスクが約70%増加する可能性があると報告されています。
◆硝酸塩の緊急時の使用とPDE5阻害薬の即時摂取が、予想されたようにリスクを回避できない可能性があり、患者には慎重で患者中心の検討が必要です。研究者は、硝酸塩治療中の男性に強壮剤を処方する前に注意が必要であると強調しています。

<関連情報>

硝酸薬とホスホジエステラーゼ-5阻害薬を服用している冠動脈疾患患者の死亡リスク Risk of Death in Patients With Coronary Artery Disease Taking Nitrates and Phosphodiesterase-5 Inhibitors

Ylva Trolle Lagerros, Alessandra Grotta, Sara Freyland, David Grannas, Daniel Peter Andersson
Journal of the American College of Cardiology Available online: 15 January 2024
DOI:https://doi.org/10.1016/j.jacc.2023.10.041

Abstract

Background
Phosphodiesterase-5 inhibitor (PDE5i) treatment for erectile dysfunction is associated with lower mortality compared with no treatment for erectile dysfunction after myocardial infarction (MI). There are conflicting results regarding the impact of PDE5i treatment on mortality in conjunction with nitrate medication.

Objectives
The purpose of this study was to investigate the association between PDE5i treatment and cardiovascular outcomes in men with stable coronary artery disease treated with nitrate medication.

Methods
Using the Swedish Patient Register and the Prescribed Drug Register we included men with previous MI or revascularization in 2006-2013 who had 2 dispensed nitrate prescriptions within 6 months. Exposure was defined as at least 2 filled prescriptions of any PDE5i. We performed multivariable Cox proportional hazard regression to estimate HRs with 95% CIs for all-cause, cardiovascular, and noncardiovascular mortality, MI, heart failure, cardiac revascularization, and major cardiovascular events (MACE).

Results
In total, 55,777 men were treated with nitrates and 5,710 men with nitrates and a PDE5i. The combined use of PDE5i treatment with nitrates was associated with higher mortality (HR: 1.39; 95% CI: 1.28-1.51), cardiovascular mortality (HR: 1.34; 95% CI: 1.11-1.62), noncardiovascular mortality (HR: 1.40; 95% CI: 1.27-1.54), MI (HR: 1.72; 95% CI: 1.55-1.90), heart failure (HR: 1.67; 95% CI: 1.48-1.90), cardiac revascularization (HR: 1.95; 95% CI: 1.78-2.13), and MACE (HR: 1.70; 95% CI: 1.58-1.83).

Conclusions
The use of a PDE5i in combination with nitrate medication in men with stable coronary artery disease may pose an increased hazard for cardiovascular morbidity and mortality. Careful patient-centered consideration before prescribing PDE5is to patients with cardiovascular disease using nitrate medication is warranted.