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• ED medication may reduce the risk of death in men who suffer from colorectal cancer 
• The reason why the drugs have an anti-tumour effect isn’t yet clear
• However, according to an expert, they are known to block a protein that may play a role in cancer development

Erectile dysfunction (ED) drugs such as Viagra, Cialis and Levitra may do more than restore sexual function – they may also prolong the lives of men with colon cancer.

That’s the conclusion of a new Swedish study, which reported that the risk of premature death dropped by as much as 18% among colon cancer patients who used ED drugs.

The medications were also linked to a 15% reduction in risk for the key cause of death from colon cancer – that is, cancer that has spread.

“This is the first population-based study to explore the effect of these drugs on the death risk in men with colorectal cancer,” said lead author Wuqing Huang, a doctoral candidate at Lund University in Sweden.

Cancer-fighting potential

She and her colleagues focused on so-called “PDE5 inhibitors” – drugs that address impotence by regulating penile blood flow.

“There are two reasons why we considered the anti-cancer possibility of these drugs,” Huang said.

Prior studies suggested that ED drugs can inhibit tumour growth in mice and the activity of a gene called PDE5A. Huang said past work suggested colon cancer patients with lower PDE5A activity levels may live “significantly longer” than others.

To get a better handle on the cancer-fighting potential of the drugs, the researchers used a nationwide database to identify men in Sweden who were diagnosed with colon cancer between 2005 and 2014.

After excluding patients with late-stage cancer, researchers focused on more than 11 300 cancer patients who were not taking an ED drug and about 1 100 patients who were. (No one was instructed to use the drugs if they weren’t already doing so.)

Over more than four years of follow-up, about 10% of those who used an ED drug died, compared to 17.5% of patients who did not. The risk was even lower for those in the ED group who also had cancer surgery.

An observational study

Huang said the explanation for the drugs’ anti-tumour effect isn’t yet clear. It could have to do with the beneficial impact EDs have on immune function, reduced cell death and chemotherapy sensitivity, she said.

But until researchers can get a better understanding, “it is not suggested for colon cancer patients to get ED medications to control their cancer at this moment,” Huang said.

“The current evidence is not enough to provide recommendations, as our study is an observational study,” she stressed. “Clinical trials are necessary to confirm it.”

Still, Dr Andrew Chan, a professor at Harvard Medical School and Massachusetts General Hospital in Boston who reviewed the study, said the findings were intriguing.

“The work extends a prior study from this group showing that these medications may reduce the risk of developing colorectal cancer,” he noted. “It is also biologically plausible that these medications may have an anti-cancer effect, since they are known to block a specific protein that may play a role in cancer development.”

The findings were recently published in the journal Nature Communications.

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• Stress and anger appear to make heart disease worse
• Pandemic-related stressors may further exacerbate the situation  
• More work is needed to find out if stress management can improve outcomes for heart failure patients

If you suffer from heart failure, try to stay calm. Stress and anger may make your condition worse, a new study suggests.

Mental stress is common in heart failure patients due to the complexities of managing the disease, progressively worsening function, and frequent medical issues and hospitalisations, according to lead author Kristie Harris, a postdoctoral associate in cardiovascular medicine at Yale University in New Haven, Connecticut.

“We have evidence that patients who experience chronically elevated levels of stress experience a more burdensome disease course with diminished quality of life and increased risk for adverse events,” Harris said in a university news release.

Mental stress test

“Clarifying the relevant behavioural and physiological pathways is especially important in the era of Covid-19 when the typical stressors of heart failure may be further compounded by pandemic-related stressors,” Harris added.

The new study included 24 heart failure patients who completed daily questionnaires for one week about their stress, anger and negative emotions.

That was followed by a mental stress test in which the patients solved maths problems and described a recent stressful experience. Echocardiograms were done to assess diastolic heart function at rest and during stress.

Diastolic function is the heart’s ability to relax and refill between beats. In heart failure, a damaged or weakened heart doesn’t pump as much blood as the body needs – a condition that can be life-threatening.

Patients who reported experiencing anger in the week before the mental stress test had worse resting diastolic pressure, the researchers found.

Stress management

According to senior study author Matthew Burg, “Factors such as mental stress and anger often go unrecognised and are under-addressed. This study contributes to the extensive literature showing that stress and anger affect clinical outcomes for patients with heart disease, adding chronic heart failure to the list that includes ischaemic heart disease (narrowed arteries) and arrhythmic disease.”

Burg, a clinical psychologist at Yale, said more work is needed to identify factors that increase vulnerability to stress in heart failure, and to find out if stress management can improve outcomes for these patients.

The study findings were published online recently in the Journal of Cardiac Failure.

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