Some 300,000 Americans with advanced heart failure might live longer if they receive left ventricular assist devices (LVADs). However, nearly half of long-term LVAD recipients experience severe adverse vascular events including strokes and bleeding—a major barrier to expanding the use of LVAD therapy. These problems may stem from LVAD-associated vascular aging, which involves stiffening of heart vessels due to collagen buildup (fibrosis).

In preliminary findings, Omar Saeed, M.D., M.Sc., and colleagues have observed that sildenafil (Viagra)—a phosphodiesterase-5 inhibitor prescribed to certain LVAD patients because of high lung pressure —appears to be linked to reduced stroke and death among those patients. The National Institutes of Health has now awarded Dr. Saeed a five-year, $2.3 million grant to conduct a double-blind, randomized placebo-controlled trial in which patients on LVAD support will receive sildenafil or placebo for at least six months. The trial will determine whether sildenafil pharmacotherapy can reduce vascular aging to potentially improve patient outcomes. The findings may also suggest whether other populations at risk of vascular disease, such as those with hypertension or diabetes mellitus, can benefit from sildenafil or other anti-fibrotic therapies.

Dr. Saeed is an associate professor of medicine at Einstein and is an attending physician at Montefiore. (1R01HL172972-01A1)