Can Viagra Cause a Heart Attack?

The drug Viagra (sildenafil) used to treat erectile dysfunction (ED) can affect blood pressure, but it is extremely rare for it to cause a major cardiovascular event like a heart attack. For most people with heart disease, Viagra and other erectile dysfunction drugs like Cialis (tadalafil) and Levitra (vardenafil) can be taken safely.

Even so, you may need to avoid Viagra if you have had a recent heart attack or stroke, have unstable angina, or are taking organic nitrates like nitroglycerin for the management of angina.

This article explores the safety of Viagra in people with heart disease as well as situations when Viagra may be contraindicated for use. It also offers tips on other ways to manage ED, including lifestyle changes and medical devices.

How Viagra Affects Heart Health

Viagra and other ED drugs classified as PDE5 inhibitors are vasodilators, meaning they work by dilating (widening) blood vessels.

With Viagra, not only are blood vessels of the penis affected but so, too, are blood vessels throughout the body. The dilation of these vessels causes a drop in the overall blood pressure.

Even so, the drop is relatively small. According to premarket studies, Viagra lowers systolic blood pressure (the top number in blood pressure readings) by an average of 8 mmHg. For most people with heart disease, including those taking medications to treat high blood pressure, this isn't a problem.

With that said, there have been rare reports of myocardial infarction (heart attack), stroke, arrhythmia (irregular heartbeat), and death in people taking Viagra. Although it's unclear whether these events were directly caused by Viagra, the patterns of deaths suggest that certain factors increase the risk of complications.

Possible Risks of Viagra

Viagra is largely regarded as safe when used as directed, but, as with all drugs, there are risks associated with its use.

While rare, the following have been reported:

• A sudden decrease or loss of hearing
• A partial or complete vision loss of one or both eyes (sometimes permanent)
• Prolonged erection for more than four hours
• Priapism (a painful erection longer than six hours that can lead to permanent damage)

Benefits of Viagra

When Viagra was first approved by the U.S. Food and Drug Administration (FDA) in 1998, it was considered a game-changer, improving the sexual function of many of the 30 million people affected by ED in the United States.

In addition to its ability to achieve and sustain erections, sildenafil's effects on blood pressure were found to be beneficial to people with pulmonary hypertension. This is a condition characterized by high blood pressure in the artery that transports blood from the heart to the lungs.

In 2005, the FDA approved the drug Revalto for the treatment of pulmonary hypertension. Revalto contains the same active ingredient as Viagra (sildenafil) but at a smaller dose. When taken as prescribed, Revalto can improve the ability to exercise and delay worsening symptoms in people with pulmonary hypertension.

Link Between Heart Disease and ED

Erectile dysfunction and heart disease are inextricably linked. People with ED have an increased risk of heart disease and vice-versa. This is because both conditions are characterized by changes in blood vessels that reduce blood circulation

In fact, studies have shown that cardiovascular diseases (CVD) account for 70% of erectile dysfunction cases. Chief among these are:

• Atherosclerosis (the narrowing and hardening of arteries)
• Hypertension (high blood pressure)
• Heart failure (the reduced ability of the heart to pump blood effectively )

Of these, atherosclerosis accounts for 50% to 60% of ED cases in people over 60.

Risk factors for ED and CVD largely mirror each other. These include high cholesterol, diabetes, obesity, and smoking.

Drug Interactions

Viagra can interact with certain drugs in different ways.

In some cases, Viagra will cause a severe drop in blood (hypotension) when taken with drugs used to treat high blood pressure. In others, the vasodilation effects of Viagra may be prolonged by the accompanying drug, increasing the risk of priapism.

Advise your healthcare provider if you take any of the following drugs with Viagra:

• Alpha-blockers like Cardura (doxazosin) and Minipress (prazosin) used to reduce blood pressure
• Other antihypertensive drugs, including ACE inhibitors and beta-blockers
• Ritonavir, used in HIV drugs and other medications (like Paxlovid), which boosts the concentration of the accompanying drug
• Other PDE5 inhibitors like Cialis, Levitra, and Revatio
• Heparin (a type of blood thinner)

Who Shouldn't Take Viagra?

Based on the current understanding of the risks of cardiovascular complications of Viagra—including heart attacks—Viagra should never be used if you:

• Have ever had an allergic reaction to sildenafil
• Had a heart attack, stroke, or life-threatening arrhythmia within the last 6 months
• Have a resting blood pressure under 90/50 mmHg
• Have a resting blood pressure over 170/110 mmHg
• Have unstable angina (chest pain)
• Take an organic nitrate to treat or prevent angina, including nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate

Viagra should be used with caution if you have conditions like:

• Aortic stenosis
• Leukemia
• Multiple myeloma
• Peptic ulcer
• Peyronie's disease
• Retinitis pigmentosa
• Sickle cell anemia
  

Non-Drug Treatment Options for ED

If you can take Viagra because of a serious heart condition or are taking a medication that can interact with Viagra, you can pursue other non-drug treatments to achieve and maintain an erection:

• Exercise: Moderate to vigorous aerobic exercise combined with weight training can improve overall cardiovascular function, including blood circulation to the penis.
• Lose weight: Losing excess pounds reduces stress on the cardiovascular system.
• Quit cigarettes: Chemicals in tobacco smoke can independently cause ED by causing blood vessels to narrow. Quitting may help reverse the risk.
• Avoid illicit drugs: Recreational drugs like cocaine, crystal methamphetamine, and opioids affect blood pressure and nerves that regulate erections. Seek medical help if you can't stop.
• Reduce alcohol: Alcohol is a depressant that can affect the nervous system and chemical messengers that enable erections. Cut back or stop entirely if you have trouble with ED.
• Try a vacuum pump: Penile vacuum pumps are cylindrical tubes placed over the penis that use suction to draw blood into the penis for an erection.

Summary

Severe cardiovascular complications caused by Viagra, like heart attack, are extremely rare. While Viagra can cause a drop in blood pressure, it is usually mild and of little concern—even if you take high blood pressure medications.

Even so, you should not take Viagra if you have had a heart attack or stroke in the past six months, if you have unstable angina, or if you use organic nitrates to manage angina. In such cases, the risk of a severe cardiovascular event may be increased.