Cialis, or tadalafil, is best known as a prescription treatment for erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). Most people associate it with improving sexual performance, but scientists have been looking beyond this familiar use.
Over the last twenty years, research has revealed that tadalafil may influence not only sexual function but also cardiovascular health, metabolism, and even blood flow in the brain.
Could a drug designed for improving sexual health also contribute to longer, healthier lives?
| 🔑 Key Takeaways ➤ Cialis enhances blood vessel function across multiple organs by sustaining cGMP and promoting healthy circulation. ➤ Its vascular benefits, such as improved endothelial function, may last even after treatment stops, suggesting longer-term support for healthy aging. ➤ Evidence points to positive effects on the heart, including reduced thickened heart muscle and stronger pumping ability, which could delay progression toward heart failure. ➤ Cialis may improve brain blood flow and oxygenation, potentially lowering risks of stroke or vascular dementia. ➤ Cialis shows promise for supporting metabolic health in people with diabetes or prediabetes. ➤ Because erectile dysfunction often signals underlying cardiovascular disease, treating ED with Cialis may also lower risks of heart attack and stroke. |
How does Cialis work?
Tadalafil, the active ingredient of Cialis, works by blocking phosphodiesterase type 5 (PDE5). This enzyme is found in certain smooth muscle tissues, like those in the penis, lungs, and prostate, and its job is to break down a chemical messenger called cyclic guanosine monophosphate (cGMP). cGMP is important because it helps relax blood vessels and smooth muscle, allowing better blood flow.
During sexual arousal, the body releases nitric oxide (NO), which triggers the production of cGMP. Higher levels of cGMP cause the muscles in the penis to relax, blood vessels to widen, and more blood to flow in, leading to an erection. By preventing PDE5 from breaking down cGMP, tadalafil makes this effect stronger and longer-lasting.
Beyond this, tadalafil’s action on blood vessels in the lungs helps lower high blood pressure in the arteries of the lungs (pulmonary arterial hypertension). In the prostate and bladder, it helps relax muscle tissue, which can ease symptoms of benign prostatic hyperplasia (BPH), such as difficulty urinating.
How can Cialis support longevity?
Cialis may support healthy aging through several pathways:
- Endothelial function and vascular aging
The endothelium is the thin layer of cells lining your blood vessels, and keeping it healthy is vital for good circulation. As we age, especially with conditions like diabetes or high blood pressure, this lining often stops working as well, a problem known as endothelial dysfunction.
Research has found that taking PDE5 inhibitors like tadalafil over time may help improve blood vessel function.
In one study, four weeks of tadalafil treatment led to arteries that widened more than twice as much as at baseline, improving from 4.2% to 9.3%. Even two weeks after stopping tadalafil, artery function was still at 9.1%, showing the effect lasted beyond treatment.
At the same time, levels of nitric oxide (which relaxes vessels) went up from about 38 to 52, while endothelin-1 (which tightens vessels) went down from 3.3 to 2.9. These changes show that tadalafil improved the body’s balance toward better blood flow.
- Cardiac structure and function
Animal studies suggested that PDE5 inhibitors such as tadalafil and sildenafil might directly benefit the heart.
A large review of studies found that in people with thickened heart muscle (left ventricular hypertrophy), PDE5 inhibitors reduced heart mass by about 12 g/m². In those without thickening, the heart’s filling capacity improved, with end-diastolic volume rising by 5 mL/m².
The heart’s pumping function also improved. Cardiac index increased by 0.3 L/min/m², and ejection fraction rose by 3.6%. Patients with severe heart thickening had lower levels of NT-proBNP, a marker of heart stress, which dropped by about 487 pg/mL. Artery function improved by about 3.3%.
The results were consistent across different groups, and the drugs were generally well tolerated.
Researchers believe these medications could be useful for men with thickened hearts or early heart failure, but larger trials, especially those including women, are still needed.
- Microcirculation and brain perfusion
Brain perfusion refers to the flow of blood through the brain that delivers oxygen and nutrients to brain tissue. Microcirculation is the movement of blood within the brain’s smallest vessels, such as capillaries. Both are important for keeping brain cells healthy and for removing waste products.
However, endothelial dysfunction can also damage the brain’s small blood vessels. This problem, known as cerebral small-vessel disease, is linked to about 1 in 4 ischemic strokes.
As the disease progresses, people may face:
- Repeated strokes
- Cognitive decline
- Severe disability
- Vascular dementia
This has led researchers to explore treatments that can improve blood vessel health in the brain, and Cialis, along with other PDE5 inhibitors, has been tested in this context.
In one study, 20 patients with a previous small-vessel stroke, average age 67, were given a single 20 mg dose of Cialis. Three hours later, oxygen levels in the brain’s small blood vessels were about 1.6% higher compared with placebo, suggesting improved microcirculation.
A separate trial with 55 participants, average age 67, showed that tadalafil increased blood flow in white matter areas by about 9.8%, though the result was not statistically significant. It did lower systolic blood pressure by 7.8 mmHg and diastolic blood pressure by 4.9 mmHg.
Another study tested daily tadalafil for three months, but patients found it harder to tolerate than the placebo. Side effects were more common in women, leading to higher dropout rates, and overall compliance did not meet the trial’s goal. While there was a hint that it might reduce brain white matter damage, the results were not strong enough to be certain.
There’s still a need for larger, longer, and possibly lower-dose studies before we can say that tadalafil really helps in cerebral small-vessel disease or vascular dementia.
- Glucose metabolism
Cialis helps restore nitric oxide signaling, which is also linked to how the body manages insulin and blood sugar. Because of this, some clinical studies suggest that PDE5 inhibitors can improve insulin sensitivity and lower blood sugar in people with type 2 diabetes or prediabetes.
In one pilot study, men with type 2 diabetes and erectile dysfunction took tadalafil 5 mg once daily. After 6 months, their HbA1c (a measure of average blood sugar over 2-3 months) fell by 0.14%, while it went up by 0.20% in the placebo group. Erectile function scores also improved more in the tadalafil group.
A broader review of studies supported these findings. On average, HbA1c dropped by about 0.40% with tadalafil, and in trials lasting 8 weeks or longer with people who had type 2 diabetes, the reduction was closer to 0.50%.
- Lower risk of problems associated with erectile dysfunction (ED)
The same vascular problems that reduce penile blood flow often affect the heart and brain. In fact, ED is sometimes considered an early warning sign of cardiovascular disease, with symptoms appearing several years before a first major adverse cardiovascular event (MACE).
Treating ED with Cialis may lower the risk of related complications and support healthier aging over the long term.
Using insurance claims data in the US, researchers compared men with ED who take tadalafil to those who don’t use PDE5 inhibitors, following them for about three years. Results showed:
- 19% lower risk of MACE, which included heart attack, stroke, heart failure, and related outcomes
- 31% lower risk of coronary revascularization, a procedure to open blocked arteries
- 45% lower risk of unstable angina, sudden chest pain from reduced blood flow to the heart
- 55% lower risk of cardiovascular death
- 44% lower risk of death from any cause
Men who took the most tadalafil had the greatest benefit, with their risk of MACE cut by about 60% compared to those with the lowest use.
Another large US study used records from more than 500,000 men with ED who were prescribed tadalafil or sildenafil. Compared to similar men who were not prescribed these drugs, PDE5 inhibitor users had:
- 24-34% lower mortality
- 17-27% lower risk of heart attack
- 22-34% lower risk of stroke
- About 20% lower risk of blood clots
- 25-32% lower risk of dementia
Tadalafil also showed stronger benefits than sildenafil. In men with urinary tract symptoms, tadalafil also reduced mortality, heart disease, and dementia risk.
While these studies are observational and cannot prove cause and effect, they support the evidence that PDE5 inhibitors may promote long-term health.
- Lower risk of problems associated with BPH
Cialis is also FDA-approved for benign prostatic hyperplasia (BPH). It works by relaxing the smooth muscles in the bladder and prostate. This improves urine flow and reduces symptoms such as frequent urination, weak stream, or difficulty starting urination.
By improving bladder emptying, Cialis may also help lower the risk of complications that come with untreated BPH. These include:
- Urinary retention
- Recurrent urinary tract infections
- Bladder stones
- Bladder damage
- Kidney problems caused by back pressure from urine buildup
Researchers analyzed over 1.1 million men with lower urinary tract symptoms (LUTS), often caused by conditions like BPH. Men taking tadalafil alone had a 41% lower risk of MACE or venous thromboembolism (VTE, blood clots in the veins) compared with men not taking tadalafil. In men using alpha-blockers, adding tadalafil was still linked to lower risk, with about a 43% reduction.
What are the risks associated with Cialis?
Cialis is generally well tolerated, with common side effects including headache, flushing, back pain, and indigestion. In long-term studies, adverse events are usually mild to moderate.
However, certain risks and precautions exist:
- Should not be used with nitrates, alpha-blockers, antihypertensives, or substantial amounts of alcohol (≥5 units) due to the risk of dangerous blood pressure drops.
- Caution in men with severe heart disease, recent stroke, or uncontrolled hypertension.
- Long-term safety in non-ED or non-BPH populations still needs more study.
Serious side effects of Cialis
Some safety concerns have also been raised, including:
Non-arteritic anterior ischemic optic neuropathy (NAION)
Rare cases of sudden vision loss linked to reduced blood flow to the optic nerve have been reported in men using PDE5 inhibitors.
While a direct cause-and-effect relationship has not been proven, men with risk factors such as diabetes, hypertension, or pre-existing eye disease should be cautious and seek medical advice if vision changes occur.
Melanoma risk
Some observational studies have suggested a link between PDE5 inhibitor use and melanoma, but other analyses found no such connection. These studies argue that the association may be explained by confounding factors, such as higher sun exposure, rather than a direct effect of the drug itself.
| 📝 Note! If you have risk factors for skin cancer, such as a personal or family history of melanoma, let your doctor know before starting Cialis. They may recommend regular dermatology checkups or closer skin monitoring while on treatment. This way, you can lower potential risks and catch any skin changes early. |
The bottom line
Growing evidence suggests that Cialis may provide benefits beyond sexual and urinary health. Large observational studies have linked its use to lower risks of death, cardiovascular disease, and dementia, with stronger effects seen compared to shorter-acting PDE5 inhibitors such as Viagra.
However, the evidence is not yet conclusive. At present, Cialis remains an established treatment for ED and BPH, with early but encouraging signs that it could also support longevity.
FAQs on Cialis for longevity
Can women take Cialis?
Cialis is not FDA-approved for female use. Some studies have explored PDE5 inhibitors for sexual dysfunction in women, yet results are mixed and not strong enough for official approval. Always consult a healthcare provider before use.
Can men without ED or BPH take Cialis?
Men who don’t have ED or BPH generally don’t need Cialis. Taking it without a medical reason may expose them to side effects like headaches, flushing, or low blood pressure without clear benefits. It should only be used under medical supervision.
Can I use Cialis for pulmonary arterial hypertension (PAH)?
Tadalafil is approved for PAH, but under a different brand name called Adcirca. While it’s the same active ingredient, the dosage and treatment approach differ from Cialis prescribed for ED or BPH. If you have PAH, your doctor may prescribe this specific formulation.
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Author Bio: Dr. Adrian Blackwell is the founder and CEO of PonteVita Rx, a telehealth practice dedicated to making medication access simpler, more affordable, and less stressful. Licensed to practice medicine in all 50 states and DC, Dr. Blackwell is board certified in obesity medicine and emergency medicine. He combines clinical expertise with personal experience navigating the healthcare system as a patient and parent to children with chronic illnesses. His mission: ensure everyone has access to their necessary medications without unnecessary barriers.
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