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Letters
May 8, 2002

Sildenafil and Physical Exertion in Men With Coronary Artery Disease

JAMA. 2002;287(18):2359-2360. doi:10.1001/jama.287.18.2359

To the Editor: Dr Arruda-Olson and colleagues1 found that sildenafil had no effect on symptoms, exercise capacity, or ischemia in men with known or probable coronary artery disease (CAD).

The authors' model of reversible myocardial ischemia has important clinical limitations. The great majority of serious cardiac events related to sexual activity—with or without sildenafil—are destined to occur not in patients with inducible ischemia caused by obstructive coronary lesions, but rather in patients who experience rupture of vulnerable but nonobstructive coronary lesions.2 Many such individuals also have diabetes, hyperlipidemia, and hypertension and use tobacco, which are themselves risk factors for erectile dysfunction, yet these patients do not exhibit inducible ischemia.3 This study was not designed to address this important group.

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