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Cardiovascular Research Advance Access first published online on May 27, 2009
This version [Corrected Proof] published online on June 17, 2009
Cardiovascular Research, doi:10.1093/cvr/cvp170
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Phosphodiesterase 5 inhibitors: are they cardioprotective?

Thorsten Reffelmann1,2,* and Robert A. Kloner2

1 Klinik und Poliklinik für Innere Medizin B, Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald, Friedrich-Löffler-Str. 23 a, 17475 Greifswald, Germany
2 The Heart Institute, Good Samaritan Hospital, Division of Cardiology, Keck School of Medicine, University of Southern California, 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395, USA

* Corresponding author. Tel: +49 3834 86 7574; fax: +49 3834 86 6657. E-mail address: thorstenreffelmann{at}web.de

A growing body of animal studies provides evidence for potential cardioprotective effects of inhibitors of the enzyme phosphodiesterase isoform 5. Infarct size reduction by administration of phosphodiesterase 5 inhibitors was described in various experimental models of ischaemia and reperfusion. Furthermore, potential beneficial effects were demonstrated in experimental models of congestive heart failure and left ventricular hypertrophy. Some of the observed effects resemble the basic mechanisms of ischaemic pre-conditioning, mimicking both acute and delayed effects. Other effects may be due to action on systemic and cardiac haemodynamics. Mechanisms and signalling pathways, characterized in some of the experimental models, appear to be complex: for instance, the rate of cyclic guanosine monophosphate (cGMP) synthesis and the functional compartmentalization of intracellular cGMP metabolism as well as interaction with ß-adrenergic and nitric oxide signalling may influence effects in different experimental settings. In this review, we discuss mechanisms, signalling pathways, and experimental limitations and touch on considerations for translation into potentially useful applications in the clinical arena.

KEYWORDS Phosphodiesterase 5; Sildenafil; Vardenafil; Tadalafil; Preconditioning

Time for primary review: 16 days


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