Cardiovascular disease is an increasingly common cause of death in women. There
is as yet no consensus on the analysis of cardiovascular risk factors with regard to the specific,
personalised treatment of pre- and post-menopausal women. Clinically significant cardioprotective
and antiremodelling effects have been observed in animal and human studies
exploring chronic inhibition of phosphodiesterase type 5 (PDE5).
The relationship between the heart, estrogens and PDE5 inhibitors (PDE5is) remains unclear.
Experimental data suggest potential beneficial effects on cardiac geometry, function, endothelial
function and microvascular coronary flow in women. It was recently postulated that the
efficacy of PDE5is is estrogen-dependent in female heart disease. A registered randomised,
placebo-controlled study, RECOGITO (NCT01803828), aimed at identifying the genderspecific
efficacy of long-term PDE5 inhibition in diabetic cardiomyopathy, is currently recruiting
patients. Estrogen receptor modulation could be a new promising approach to heart
protection via PDE5is. PDE5is could be indicated as a gender-oriented strategy in modulated
cardiac dysfunction and remodelling and in cardiac risk factors for selected cardiovascular
Keywords: Gender, estrogen, PDE5is, NO, cGMP, heart, cardiovascular disease, endothelial function.
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