The coexistence of cardiovascular disease and erectile dysfunction is widespread, possibly owing to underlying endothelial dysfunction in both diseases. Millions of patients with cardiovascular disease are prescribed phosphodiesterase-5 (PDE5) inhibitors for the management of erectile dysfunction. Although the role of PDE5 inhibitors in erectile dysfunction therapy is well established, their effects on the cardiovascular system are unclear. Preclinical studies investigating the effect of PDE5 inhibitors on ischemia–reperfusion injury, pressure overload-induced hypertrophy, and chemotoxicity suggested a possible clinical role for each of these medications; however, attempts to translate these findings to the bedside have resulted in mixed outcomes. In this review, we explore the biologic preclinical effects of PDE5 inhibitors in mediating cardioprotection. We then examine clinical trials investigating PDE5 inhibition in patients with heart failure, coronary artery disease, and ventricular arrhythmias and discuss why the studies likely have yet to show positive results and efficacy with PDE5 inhibition despite no safety concerns.

心血管疾病和勃起功能障碍普遍共存，可能是由于这两种疾病都存在潜在的内皮功能障碍。数百万心血管疾病患者服用磷酸二酯酶 5 (PDE5) 抑制剂来治疗勃起功能障碍。尽管 PDE5 抑制剂在勃起功能障碍治疗中的作用已明确，但其对心血管系统的影响尚不清楚。临床前研究调查了 PDE5 抑制剂对缺血再灌注损伤、压力超负荷引起的肥大和化学毒性的影响，表明这些药物可能具有临床作用；然而，尝试将这些发现转化为临床结果却产生了好坏参半的结果。在这篇综述中，我们探讨了 PDE5 抑制剂在介导心脏保护方面的临床前生物学作用。然后，我们检查了研究 PDE5 抑制治疗心力衰竭、冠状动脉疾病和室性心律失常患者的临床试验，并讨论了为什么这些研究可能尚未显示出积极的结果和 PDE5 抑制的功效，尽管没有安全性问题。