Thread by @afshineemrani

1/5
I'm a cardiologist. Here's why I recommend men take 5 mg of tadalafil — Cialis — every single day.
Not for ED. Not for performance.
I take it for the same reason every serious longevity physician I respect does: to protect my cardiovascular system, my brain perfusion, and my endothelial health at the most fundamental level.
This drug — famous for all the wrong reasons — has quietly become one of the most powerful tools in preventive cardiology. And the data is now too strong for me to keep quiet about it.

2/5
Here's what tadalafil actually does.
PDE5 is the enzyme that breaks down cGMP — the molecule that tells your smooth muscle to relax and your blood vessels to dilate. By blocking PDE5, tadalafil produces system-wide vasodilation: better blood flow to the heart, brain, lungs, kidneys, muscles — every organ downstream of your vascular tree.
Unlike Viagra, which lasts 4-6 hours, tadalafil's effects last up to 36 hours. A low daily dose keeps plasma levels stable around the clock.
Now here's why this matters for your heart.
Endothelial dysfunction — the failure of that thin layer of cells lining 60,000 miles of your blood vessels — is the earliest, most predictive marker of cardiovascular disease. It precedes plaque, heart attacks, and strokes by years. By the time most patients reach my office, the damage is done.
Tadalafil directly improves endothelial function. It reduces arterial stiffness. It shows anti-fibrotic effects on the heart muscle in preclinical models. It's already FDA-approved for pulmonary arterial hypertension.
Most patients come to me when something has already broken. I'm treating the pipes before they clog.

3/5
The population-level data made this decision easy for me.
A longitudinal study analyzing over 500,000 men from the TriNetX database — one of the largest real-world datasets in medicine — found tadalafil was associated with:
34% reduced all-cause mortality. 27% reduced heart attacks. 34% reduced stroke. 21% reduced venous thromboembolism. 32% reduced dementia.
Half a million men. Three-year follow-up. Propensity-matched for demographics and eight pre-existing conditions.
A separate meta-analysis pooling data from over 8 million individuals found PDE5 inhibitor use associated with a 47% reduction in Alzheimer's risk.
A UK study of nearly 270,000 men found that those with 20 or more tadalafil prescriptions had a 44% reduction in dementia risk.
I want to be transparent: these are observational studies, not randomized controlled trials. But the consistency of the signal across multiple large databases, the biological plausibility, and the established safety profile make this a compelling addition to a longevity protocol.

4/5
Your brain is 2% of your body weight but demands 20% of your cardiac output. Any compound that meaningfully enhances cerebral blood flow is, by definition, a cognitive protector.
Tadalafil is being actively investigated in clinical trials for vascular dementia and cognitive decline caused by poor cerebral perfusion. The mechanism is the same — better vasodilation, better oxygen delivery, better nutrient transport to the organ that matters most.
For athletes — better blood flow means better oxygen delivery to working muscle, faster recovery, reduced exercise-induced inflammation, and measurable improvements in endurance. Studies at high altitude show real advantages. This isn't a stimulant. It's superior vascular infrastructure.
Short-term you notice: lower resting blood pressure, sharper mental clarity, better performance in the gym, and yes — stronger erections.
Long-term you're building: the cardiovascular system you were supposed to have.

5/5
My protocol:
2.5-5 mg daily, same time each day. Food doesn't affect absorption. Avoid grapefruit — it can spike levels unpredictably.
Critical safety — do NOT combine with nitrates. Nitroglycerin, isosorbide, poppers. The combination causes a dangerous blood pressure drop. Use caution with very low baseline blood pressure or certain CYP3A4 inhibitors. Always discuss with your own physician.
This drug has 20+ years of clinical safety data across millions of prescriptions. It's well-established. It's generic. It costs pennies a day.
I call it Vitamin C-ialis.
Because in 20 years, when my vascular age is still tracking 15 years younger than my chronological age, I'll know exactly why.
This isn't about the bedroom. It's about keeping the most important infrastructure in your body functioning at peak performance for as long as humanly possible.
And yes — the bedroom advantage is a nice bonus.
Not medical advice. Talk to your physician. But if you're serious about longevity and cardiovascular optimization, this is one of the highest-ROI interventions I've found in twenty years of practice.