title: Phosphodiesterase type-5 inhibitor use in type 2 diabetes is associated with a reduction in all-cause mortality.
abstract: Experimental evidence has shown potential cardioprotective actions of phosphodiesterase type-5 inhibitors (PDE5is). We investigated whether PDE5i use in patients with type 2 diabetes, with high-attendant cardiovascular risk, was associated with altered mortality in a retrospective cohort study.
  
  
  
  Between January 2007 and May 2015, 5956 men aged 40-89 years diagnosed with type 2 diabetes before 2007 were identified from anonymised electronic health records of 42 general practices in Cheshire, UK, and were followed for 7.5 years. HRs from multivariable survival (accelerated failure time, Weibull) models were used to describe the association between on-demand PDE5i use and all-cause mortality.DC1SM110.1136/heartjnl-2015-309223.supp1Supplementary appendix RESULTS: Compared with non-users, men who are prescribed PDE5is (n=1359) experienced lower percentage of deaths during follow-up (19.1% vs 23.8%) and lower risk of all-cause mortality (unadjusted HR=0.69 (95% CI: 0.64 to 0.79); p<0.001)). The reduction in risk of mortality (HR=0.54 (0.36 to 0.80); p=0.002) remained after adjusting for age, estimated glomerular filtration rate, smoking status, prior cerebrovascular accident (CVA) hypertension, prior myocardial infarction (MI), systolic blood pressure, use of statin, metformin, aspirin and β-blocker medication. PDE5i users had lower rates of incident MI (incidence rate ratio (0.62 (0.49 to 0.80), p<0.0001) with lower mortality (25.7% vs 40.1% deaths; age-adjusted HR=0.60 (0.54 to 0.69); p=0.001) compared with non-users within this subgroup.
  
  
  
  In a population of men with type 2 diabetes, use of PDE5is was associated with lower risk of overall mortality and mortality in those with a history of acute MI.
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford, UK.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
authors.forename: David C
authors.initials: DC
authors.lastname: Hutchings
authors.affiliation: The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford, UK The George Institute for Global Health, University of Sydney, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford, UK.
authors.forename: Kazem
authors.initials: K
authors.lastname: Rahimi
authors.affiliation: Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, UK.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Rutter
authors.affiliation: The Centre for Research in Primary & Community Care, University of Hertfordshire, Hatfield, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Kirby
authors.affiliation: Department of Urology, Good Hope Hospital, Sutton Coldfield, UK.
authors.forename: Geoff
authors.initials: G
authors.lastname: Hackett
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Trafford
authors.affiliation: School of Medicine, and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK Leighton Hospital, Crewe, UK.
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Heald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000401:mortality*; D057286:Electronic Health Records; D004739:England / Q000453:epidemiology; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D058006:General Practice; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D065840:Protective Factors; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058986:Phosphodiesterase 5 Inhibitors