Research SquareOct 19, 2026, 16:24 BST

Tadalafil tied to survival in men 40+ with erection or urinary issues

Death risk ratios were 0.574 for daily 5 mg tadalafil and 0.617 for on-demand 20 mg versus non-users; values below 1 indicate lower relative risk.

Paper by Yeow Siong Lee, Chuan-Shu Chen, Gu-Shun Lai, Jianyi Li

Figure 1. Flow diagram illustrating patient identification, eligibility assessment, application of exclusion criteria, and final cohort selection.Flow diagram illustrating patient identification, eligibility assessment, application of exclusion criteria, and final cohort selection.Lee et al.

Preprint: cohort study in peopleInterventions

Paper

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A retrospective observational study examined US health records for men aged 40 or older with erectile dysfunction—difficulty getting or keeping an erection—and/or lower urinary tract symptoms affecting urination. It included 28,376 men prescribed tadalafil 5 mg daily, 31,321 prescribed 20 mg on demand, and 1,066,587 who did not receive phosphodiesterase type 5 inhibitors, the drug class that includes tadalafil.

Researchers matched groups on demographic characteristics and major medical conditions. Within a 14-year follow-up period, both regimens were associated with lower risks of death, stroke, heart failure and ischemic heart disease, which involves reduced blood supply to the heart, compared with non-use. In a separate matched comparison, on-demand tadalafil was associated with more favorable overall survival and survival free of cardiovascular disease than daily tadalafil.

Why it matters

Erectile dysfunction and urinary symptoms are common in middle-aged and older men. Randomized studies could test whether tadalafil offers cardiovascular benefits beyond relief of these symptoms.

Caveats

This observational study cannot establish causation, because matching may leave unmeasured differences between groups. The preprint has not been peer-reviewed, excluded men with pre-existing major cardiovascular disease and reported no harms data in its abstract.

From the paper

Participants

Between 1 January 2012 and 31 December 2022, a total of 2,070,812 men with erectile dysfunction (ED) and/or lower urinary tract symptoms (LUTS) were identified within the TriNetX US Collaborative Network.

Methods, Study population

Result

… all-cause mortality (RR 0.574, 95% CI 0.535–0.615),

Results, Mortality and cardiovascular outcomes

Quoted word for word from the full text on researchsquare.com.