HealthDay News — For men prescribed nitrates for ischemic heart disease (IHD), new prescriptions of phosphodiesterase type 5 (PDE5) inhibitors increased from 2000 to 2018, but an association between coprescription and adverse cardiovascular events was not observed, according to a study published online April 19 in the Annals of Internal Medicine.

Noting that concomitant use of nitrates and PDE5 inhibitors is contraindicated, Anders Holt, MD, from Copenhagen University Hospital-Herlev and Gentofte in Denmark, and colleagues conducted a nationwide case-crossover design study of men with IHD, including those who had a continuing prescription for nitrates and a new, filled prescription for PDE5 inhibitors. Data were included for 249,541 male patients with IHD identified from 2000 to 2018, of whom 42,073 had continuing prescriptions for nitrates.

The researchers found that from 2000 to 2018, there was an increase in the prescription rate for PDE5 inhibitors among patients with IHD who were taking nitrates, from an average of 0.9 to 19.5 prescriptions per 100 persons per year. There was no statistically significant association between the coprescription of nitrates with PDE5 inhibitors and the risk for either composite outcome: 1) cardiac arrest, shock, myocardial infarction, ischemic stroke, or acute coronary arteriography; and 2) syncope, angina pectoris, or a drug-related adverse event.

“In this carefully conducted study of concomitant use in a nationwide population, we could not find a statistically significant association with an increased cardiovascular risk after a filled prescription of PDE5 inhibitors among patients receiving nitrates,” the authors write.

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