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The key question isn't whether it works in the short term, but whether it remains safe and beneficial when used long-term

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As the levels and the activities of pyruvate carboxylase (PC) and pyruvate dehydrogenase (PDH) are high in beta cells, these enzymes provide two routes for metabolism of glycolysis-derived pyruvate: either oxidation by PDH to acetyl-CoA or carboxylation by PC to oxaloacetate [29, 30] (Fig

Indeed, current guidelines do not recommend administration of PDE5i to patients with unstable angina, severe congestive heart failure, or uncontrolled hypertension, patients at high risk for arrhythmias, and patients receiving nitrates [13]