This is an interesting study: https://doi.org/10.1002/clc.24234

PDE5 inhibitors are not just for erectile dysfunction.

There are several large observational studies (not a double blind study) that show lower all-cause mortality in men who are being prescribed tadalafil.

A 2024 paper in Clinical Cardiology looked at men with erectile dysfunction in a large commercial insurance database linked to the National Death Index. Researchers compared 8,156 men with at least one tadalafil claim to 21,012 men with no PDE-5 inhibitor claims.

The groups were matched on age, smoking, coronary disease, diabetes, blood pressure, cholesterol, and preventive medicines.

Over about 3 years, tadalafil exposure was linked to lower rates of: Major heart events:

19% lower Coronary revascularization:

31% lower Unstable angina:

45% lower Cardiovascular death:

55% lower Death from any cause:

44% lower Men with the most tadalafil exposure had the lowest event rates.

Smaller groups with diabetes or known coronary disease showed a similar pattern, but those results were not statistically significant. This is an observational study, not a randomized trial. It cannot prove tadalafil caused the benefit.

Healthier patients, more sexual activity, or other unmeasured factors could explain the findings. The authors say placebo-controlled trials are still needed. The important thing to remember is that the PDE5 inhibitors block the enzyme PDE5, which helps relax blood vessel smooth muscle, increasing blood flow throughout the body.