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May 8, 2002

Sildenafil and Physical Exertion in Men With Coronary Artery Disease—Reply

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

In Reply: We agree with Dr DeBusk that stress testing—with or without sildenafil—will not identify patients prone to plaque rupture involving nonobstructive coronary lesions. Nevertheless, stress echocardiography has been shown to identify patients at risk of myocardial infarction and cardiac death, which has been demonstrated in both sexes1 and in patients aged 65 years and older.2 As we acknowledged, our study was powered to detect differences in extent and severity of ischemia with sildenafil compared with placebo. Larger numbers of patients must be studied to determine the effect of sildenafil on infrequently occurring clinical events.

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