Can tadalafil help you live longer? Here's what the studies show

Several large observational studies have found that men prescribed PDE-5 inhibitors fare better than men who aren't.

A 2024 analysis in Clinical Cardiology followed 8,156 men with ED who took tadalafil against 21,012 who took no PDE-5 inhibitor, matching both groups for smoking, diabetes, hypertension, cholesterol, and preventive medications.

Major adverse cardiovascular events were 19 percent lower in the tadalafil group. Cardiovascular mortality was 55 percent lower, and all-cause mortality 44 percent lower. Notably, the effect tracked with exposure: men in the highest quartile of tadalafil use had roughly 60 percent lower MACE rates than those in the lowest.

A far larger study published in The American Journal of Medicine in March 2025 drew on records from 50 million American men, ultimately analyzing 509,788 with ED and over a million with lower urinary tract symptoms.

Among men 40 and older with ED and no prior cardiovascular disease, tadalafil was associated with lower rates of death, heart attack, stroke, venous thromboembolism, and dementia. Sildenafil showed similar but consistently smaller benefits, and tadalafil outperformed it head-to-head on mortality, MI, and stroke.

Every major study showing mortality and dementia benefits is observational and retrospective. They demonstrate association, not causation, and the confounding problem here is specific: men who seek treatment for ED may simply be healthier, more engaged with the medical system, or more sexually active than men who don't. Researchers can't fully separate the drug from the man taking it.

"It's a serious area of discussion," says Dr. Robert Kloner of Huntington Medical Research Institutes. "Cardiovascular disease remains the number one killer, and we have these drugs that may have a potential benefit, but we have to learn a lot more."

The trials that would settle it may never happen. Tadalafil and sildenafil are both generic, so no manufacturer has a commercial incentive to fund the large, expensive prevention study that the question deserves.

But there are signs of very cautious movement. The Princeton Consensus Panel, meeting in June, reached consensus language that low-dose tadalafil is "appropriate" for a subset of men at elevated cardiovascular risk from arterial plaque, though some members were hesitant given the absence of trials, and the recommendations aren't yet published.

"This is not for all men," said panel co-chair Dr. Martin Miner of Brown University.