Sildenafil (Viagra) and Aortic Dilation/Aneurysm

@carlwgordon Asked in another thread about the risk of Viagra in the presence of aortic dilation of 4.1 cm.

An echocardiogram is often done during investigation of potential cardiac problems. I have had several done since 2013, for reasons other than concern about a dilated aorta. However, it was discovered that my ascending aorta (the part of this artery which is closest to the heart itself) is 4.1 cm wide. This is technically "dilated", with the very upper limits of normal being 4.0. The wider the aorta gets, the "flimsier" its wall is, to the point that it may start to balloon out under the pressure of blood being ejected from the heart...an aneurysm. The wider an aneurysm, the more likely it is to burst, which is a potentially life threatening situation of immediate concern.

My own aorta is very minimally dilated, and is not getting progressively wider. My doctors (cardiology and family practice) have not advised me to alter my life style in any way, even knowing that I have been participating in triathlons up at and including Ironman at a very high level for 25 years. But the issue of Viagra use was never raised, even though my FP at least is aware of my recent prostate surgery.

Viagra affects the smooth muscle of the heart and blood vessels, causing them to loosen and relax. That's why it works to help increase blood flow into the penis and help with erectile formation. That same feature of smooth muscle dilation *might* be a risk factor for a dilated aorta.

A quick literature search ( Google: Viagra and Aortic Dilation) revealed several articles of interest:

https://www.ahajournals.org/doi/10.1161/circ.144.suppl_1.9487...A study in mice who had aortic aneurysms (abdominal, nor ascending) induced and then were given sildenafil showed that the aorta was indeed weakened. The authors conclude: "Our findings may raise the caution of clinical usage of Viagra in aneurysmal patients."

https://academic.oup.com/icvts/article/9/1/141/720366...A case report with literature search of a young man who had an aneurysm following ingestion of Viagra. They conclude: "The patients for whom sildenafil use is suitable should undergo not only an examination for coronary artery disorder but also the diseases that will affect the aorta; physical examination should definitely be accompanied by an echocardiographic examination."

While my heart has not yet broken due to Viagra use, I intend to stop taking it. I am now 18 months post surgery, with what I regard as full return of erectile function. E.g., I have nocturnal erections, and am able to achieve penetrative sex without the use of the drug.

The studies cited above are in the cardiology literature, not urology or oncology. And most cases of mild aortic dilation will not be symptomatic. So finding good advice within one's medical team might take some work.