Infarto Agudo do Miocárdio (IAM) associado ao uso de Tadalafila: uma revisão integrativa

Abstract

INTRODUCTION: Cardiovascular diseases remain among the leading causes of morbidity and mortality worldwide; acute myocardial infarction (AMI)—a major manifestation of coronary artery disease associated with high mortality rates and a significant impact on healthcare systems—is particularly notable. Early diagnosis via electrocardiography and cardiac biomarkers, combined with treatment based on reperfusion therapies, is crucial for reducing mortality. Concurrently, erectile dysfunction is common in patients with cardiovascular disease, and tadalafil is one of the primary medications used to treat it. However, given its vasodilatory effect and the contraindication regarding concomitant use with nitrates, it is essential to understand its cardiovascular safety profile and any potential association with acute myocardial infarction. OBJECTIVE: To analyze the relationship between tadalafil use and potential clinical consequences, focusing on its association with ischemic events, such as acute myocardial infarction. METHODOLOGY: This is an integrative literature review conducted using the Virtual Health Library (VHL), PubMed, and Scopus databases, employing DeCS and MeSH descriptors combined with the Boolean operators AND and OR. Inclusion criteria comprised peer-reviewed studies published between March 2016 and March 2026—available in full text, in Portuguese or English, and involving an adult population—that addressed the PICO strategy. Study selection followed PRISMA (2020) recommendations, and data were organized and analyzed descriptively and critically, resulting in a final sample of 10 articles. RESULTS AND DISCUSSION: The studies analyzed show no evidence of a conclusive association between tadalafil use and an increased risk of acute myocardial infarction (AMI). Conversely, the findings suggest a favorable cardiovascular safety profile, with a potential cardioprotective effect linked to improved endothelial function, increased availability of nitric oxide and cyclic guanosine monophosphate (NO/cGMP), and a reduction in mortality and other cardiovascular events. However, concomitant use with nitrates remains contraindicated due to the risk of severe hypotension, myocardial ischemia, and other adverse outcomes. Despite promising results, the predominance of observational studies and the scarcity of specific research on the direct link between tadalafil and AMI underscore the need for further clinical trials to confirm these findings. CONCLUSION: The results of this review show no evidence of an association between tadalafil use and an increased risk of acute myocardial infarction (AMI). The evidence suggests a favorable cardiovascular safety profile, associated with improved endothelial function, increased NO/cGMP availability, and a reduction in mortality and other cardiovascular events. Recreational and indiscriminate use of tadalafil combined with antihypertensives, alcohol, or illicit drugs can cause a drastic drop in blood pressure, increasing cardiovascular risks and potentially leading to death.