Inhibidores de la fosfodiesterasa 5 y salud cardiovascular: del riesgo a la seguridad y a la potencial protección. (Spanish)

Phosphodiesterase-5 inhibitors and cardiovascular health: from risk to security and potential protection. (English)

Phosphodiesterase 5 inhibitors (PDE5i) have been available on the market for more than 25 years and currently represent the first line of treatment for erectile dysfunction. The mechanism of action of PDE5i, which is associated with a vasodilatory effect through nitric oxide, led to the assumption in the early years that these drugs could be associated with an increased risk of major cardiovascular events, such as acute myocardial infarction, angina, and stroke. We evaluated the latest evidence related to the use of PDE5i and cardiovascular health from the last 15 years. Analysis of prospective, multicenter studies and real-life experience with hundreds of millions of doses administered worldwide demonstrate that PDE5i are safe from a cardiovascular point of view, even in high-risk patients. In recent years, evidence from retrospective studies has indicated that these drugs would also have a protective role in reducing the morbidity and mortality associated with these events. The evidence regarding the cardiovascular safety of PDE5i is overwhelming. The evidence regarding a potential protective effect on cardiovascular events associated with the use of PDE5i currently comes only from retrospective studies and must be demonstrated in prospective studies before being recommended as a therapeutic measure. [ABSTRACT FROM AUTHOR]

Los inhibidores de la Fosfodiesterasa 5 (iPDE5) llevan más de 25 años presentes en el mercado y representan actualmente la primera línea de tratamiento para la disfunción eréctil. Su mecanismo de acción, que se asocia a un efecto vasodilatador a través del óxido nítrico, hizo presumir en los primeros años que estos fármacos podían asociarse a un aumento del riesgo de eventos cardiovasculares mayores, como infarto agudo al miocardio, angina y accidente vascular cerebral. En esta revisión se evalúa la evidencia disponible relacionada con el uso de iPDE5 y su efecto sobre la salud cardiovascular en los últimos 15 años. El análisis de estudios prospectivos, multicéntricos y experiencia de vida real con cientos de millones de dosis administradas en todo el mundo demuestran que los iPDE5 son seguros desde el punto de vista cardiovascular, incluso en pacientes de alto riesgo. En los últimos años se ha acumulado evidencia proveniente de estudios retrospectivos que indica que estos fármacos tendrían además un rol protector disminuyendo la morbimortalidad asociada a estos eventos. La evidencia respecto a la seguridad cardiovascular de los iPDE5 es contundente. La evidencia en cuanto a un potencial efecto protector de eventos cardiovasculares asociada al uso de iPDE5 actualmente proviene solo de estudios retrospectivos y deberá ser demostrada en estudios prospectivos, antes de ser recomendada como una medida terapéutica. [ABSTRACT FROM AUTHOR]

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