title: Everything you ever wanted to know about phosphodiesterase 5 inhibitors and the heart (but never dared ask): How do they work?
abstract: BACKGROUND
  Phosphodiesterase 5 inhibitors (PDE5i) were developed while investigating novel treatments for coronary artery disease, but their andrological side effects shifted their indication toward the management of erectile dysfunction. Although PDE5i are now also indicated for pulmonary arterial hypertension and there are mounting preclinical and clinical evidences about their potentially beneficial cardiac effects, their use remains controversial and the involved mechanisms remain unclear.
  
  
  METHODS
  This review aimed to analyze the effects of PDE5i administration in various animal and humans models of cardiovascular diseases.
  
  
  RESULTS
  Animal studies have shown that PDE5i have protective effects in several models of cardiac disease. In humans, some studies showed that PDE5i improves microvascular and endothelial dysfunction and exerts positive effects in different samples of cardiovascular (CV) impairment. In contrast, other studies found no benefit (and no harm) in heart failure with preserved ejection fraction. The discrepancies in these findings are likely related to the fact that the mechanisms targeted by PDE5i in human disease are still poorly understood and the target population not yet identified. The mechanisms of actions herein reviewed suggest that hypertrophy, microvascular impairment, and inflammation, should be variably present for PDE5i to work. All these conditions frequently coexist in diabetes. A gender responsiveness has also been recently proposed.
  
  
  CONCLUSIONS
  Continuous PDE5 inhibition may exert cardioprotective effects, improving endothelial function and counteracting cardiac remodeling in some but not all conditions. A better patient selection could help to clarify the controversies on PDE5i use for CV disorders.
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Pofi
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Gianfrilli
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Badagliacca
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Di Dato
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Venneri
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. elisa.giannetta@uniroma1.it.
authors.forename: E
authors.initials: E
authors.lastname: Giannetta
mesh_terms: D000818:Animals; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D006331:Heart Diseases / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D055806:Microvessels / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D009206:Myocardium / Q000201:enzymology / Q000378:metabolism; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015203:Reproducibility of Results
chemical_list: D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D058986:Phosphodiesterase 5 Inhibitors
keywords: Cardiovascular disease; Endothelial function; PDE5; Remodeling; cGMP