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Heart failure is a long term health condition where the heart can’t pump enough blood (and hence oxygen) to the rest of the body. Sildenafil, the active ingredient in Viagra, may be able to treat it.
In the United States, nearly 6 million adults have heart failure, and around one of nine deaths has heart failure as a contributing factor. Heart failure is serious. Around half of people who develop heart failure die within five years of being diagnosed, and the total costs of heart failure each year are nearly $31 billion, including healthcare costs, medications, and lost productivity.
Symptoms of heart failure include shortness of breath during ordinary activities, difficulty breathing when lying flat, swelling of the feet, legs, or abdomen, and a general tired, weak feeling. There’s no single treatment that fixes heart failure, but treatment typically involves medications, reduction in sodium intake, and daily physical activity. Predictive factors for heart disease include coronary artery disease, heart attack, high blood pressure, and diabetes. Lifestyle factors like smoking, being sedentary, and having a high-fat diet increase the risk of developing heart failure.
The Recent University of Manchester Study
Popular erectile dysfunction drug Viagra, which contains the active ingredient sildenafil citrate, was originally studied as a treatment for a painful heart condition called angina. Though it didn’t work as expected, the side effect of better erections heralded a second, wildly popular use for the drug. But over the years, researchers have continued to study Viagra as a possible treatment for many diseases, including heart diseases other than angina.
A recent study by researchers at the University of Manchester in the UK found that cells from a heart that is failing can survive longer when a Viagra-like drug is administered. The research team is now trying to learn whether the drug can prevent dangerous abnormal heart rhythms, which are responsible for a high proportion of heart failure deaths. And the same group has studied whether the use of Viagra in diabetics reduces their heart attack risk, and it appears that it does. Six thousand male diabetic patients who were taking Viagra for erection problems were found to have a lower risk of heart attack or death from heart failure than a control group that did not take the drug.
Viagra Not Effective with All Types of Heart Failure
There are actually several types of heart failure, and Viagra doesn’t appear to help with all of them. For example, a 2013 study tested Viagra on patients with diastolic heart failure. In this type of heart failure, the lower chambers of the heart become stiff and cannot relax enough to fill sufficiently between heartbeats.
The patients with diastolic heart failure were quite ill and had severely limited exercise capability and significant heart structural abnormalities. They took Viagra for 24 weeks and were tested on how far they could walk during six minutes. Patients were also scored based on quality of life, and heart structure and function after having taken the drug.
Unfortunately, Viagra didn’t appear to help these patients, but researchers think the drug might yet help patients with diastolic heart failure who also have high blood pressure and pulmonary arterial hypertension (a condition that has long been treated with a version of Viagra called Revatio). They recommend that research using Viagra could be done on a subset of diastolic heart failure patients with high blood pressure or pulmonary arterial hypertension.
It May Work Differently in Female Patients
Another concern with using Viagra as a treatment for heart failure or heart damage is that the drug apparently works differently in men than in women. In studies involving mice, Viagra did not work when mice had had their ovaries removed (and therefore had extremely low estrogen levels). So it would appear that in women, Viagra requires the presence of estrogen to help with heart failure. In men, the drug targets an entirely different biological process that doesn’t involve estrogen, so the presence of estrogen isn’t necessary for the drug to work in men.
In men, the drug, which inhibits an enzyme called PDE5, causes a rise in the levels of another molecule called cGMP, which may be depleted after heart problems occur. In male mice, Viagra blocked and reversed so-called cardiac remodeling of the heart, and improved the health of the mice with heart failure. So, depending on the type of heart failure and estrogen levels in female heart patients, Viagra may or may not help with heart failure.
2009 Study of Systolic Heart Failure
In contrast to diastolic heart failure, where the lower chambers of the heart stiffen, systolic heart failure is a failure of the ventricles of the heart to contract normally. In patients with systolic heart failure, the administration of sildenafil improves exercise capacity, and has been associated with improvements in endothelial function. Endothelial function refers to how well the inner lining of blood vessels works in terms of balancing vasodilation and vasoconstriction depending on bodily needs. Reduction in larger artery stiffness following sildenafil treatment is another factor that helps with exercise capacity and quality of life measures in patients with systolic heart failure.
1999 Consensus Document Was Cautiously Optimistic
Back in 1999, Viagra was still a new treatment for erectile dysfunction, and memories of its inability to treat angina were still on many researchers’ minds. You have probably noticed that advertisements for Viagra always state that men who take nitrates for heart problems should not take Viagra because of the risk of a dangerous drop in blood pressure.
All of that is still true, but even in Viagra’s early days, the American Heart Association conceded that while the drug isn’t for use in people who take nitrates, nor people with coronary ischemia who don’t take nitrates, nor people who take complex multi-drug hypertension regimens, it could have benefits in heart patients. Specifically, since sildenafil is a PDE5 inhibitor that is highly selective of PDE5 over another enzyme called PDE3, it is worth studying. That’s because PDE3 inhibitors are associated with cardiotoxicity and actually increase long-term mortality rates in heart failure patients. PDE3 inhibitors are used to treat cardiogenic shock when therapy with other drugs is ineffective, and they are only administered when their considerable risks are balanced against potential benefits.
Heart Failure and Erection Problems Often Go Together
It also bears mentioning that heart failure and erectile dysfunction often go together. The two conditions share several common risk factors, such as diabetes, high blood pressure, and high cholesterol. Furthermore, some of the therapies used in heart failure patients, like beta-receptor blockers and diuretics can worsen erection problems.
Erectile dysfunction, particularly in younger men, is now seen as a potential indicator of cardiovascular issues. The good news is the lifestyle modifications that help people who have heart disease are also helpful in treating erectile dysfunction. Lowering cholesterol levels, quitting smoking, and taking up a healthier diet and regular exercise are measures that improve circulation in general, and they can affect quality of erections whether or not men take Viagra. In men who are prescribed Viagra, steps like losing excess weight, stopping smoking, and controlling blood glucose levels more tightly can help the drug work even better.
It’s no surprise that heart problems and erection problems go together. After all, Viagra started out as a potential treatment for heart problems. Today, things are, in some ways, coming full circle, with the drug finding several potential uses in people who have certain types of heart problems. Research is ongoing, but the use of Viagra as a treatment for people with systolic heart failure in particular may be an important breakthrough in helping these heart patients enjoy a higher quality of life.
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