Brian, for the love of god, you cannot take a health database, click 'sort' and think that the top 5 drugs patients who survive longer happen to be taking are causal to the benefit those patients received. 500k is actually not a large cohort for a database, needs alpha correction, was very unlikely to be prespecified, etc. that's why no one is impressed with these studies and they're published in trash journals.
this study showed a slight increase in CV events with PDEs vs placebo
pubmed.ncbi.nlm.nih.gov/1452…
the mechanistic rationale is not there and your explanation is terrible. ALL PDEs metabolize cAMP/cGMP, thats why they are phosphodiesterases. are you suggesting we should inhibit all PDEs?!
by the same logic we should all be taking ERAs too. why not ARBs and ACEs? screw it i'll take inhaled treprostinil too. might extend my life. then i'll run SQL queries on health databases until i see a 'signal', bonferroni may roll in his grave but i will be vasodilated.