Most people being treated for heart disease can safely have sex, according to research that also suggests the risk of sudden cardiac death may rise for men when the amorous activity occurs in an extramarital affair.
Having sex is linked with less than 1 percent of all heart attacks and less than 5 percent of incidences of chest pain, the American Heart Association reported today. More than 27 million Americans have heart disease, the nation's top cause of death, according to the Centers for Disease Control and Prevention.
The act of intercourse is generally comparable to climbing two flights of stairs, said Glenn Levine, a professor of medicine at Baylor College of Medicine in Houston and the paper’s lead author. The scientific statement, published in the Dallas-based heart group’s journal, Circulation, may provide a road map for doctors to counsel patients, he said.
“It is only a modest number of patients with more severe or unstable symptoms who should defer sexual activity until evaluated and treated,” Levine said in a telephone interview. “Our recommendations apply to anyone of any age with heart disease, including younger persons with congenital heart disease and other patients including patients in their 70s and 80s.”
Levine’s research group reviewed more than 100 studies to determine the risks. In autopsy reports of 5,559 cases of sudden death, 0.6 percent occurred during sexual intercourse, they found. Of those who died, 82 percent to 93 percent were men and 75 percent were having extramarital sex, in most cases with a younger partner and after excessive food and alcohol consumption, the report said.
Risk of Affairs
The study on the autopsy reports involved “only a very modest number of patients,” and thus “there is no way to know how much, if any, an extramarital affair relationship truly increases risk or the mechanism,” said Levine, who directs the Cardiac Care Unit at the Michael E. DeBakey VA Medical Center.
“I would not blow this too out of context,” he said. “Without being sarcastic, I really can state that I have not ever had a patient who asked me about the cardiac risks of an extramarital affair.”
While the risk of heart attack during sexual activity is about 2-3 times higher than during periods when one isn’t engaging in sexual activity, the actual absolute risk of heart attack during sexual activity is minuscule, according to Levine.
Patients should know that sexual relations are an important part of getting their lives back to normal after heart disease and should feel comfortable talking about their sexual activity with their doctors, said cardiologist Peter Alagona, co-director of the Penn State Hershey Heart and Vascular Institute’s Cardiac Rehabilitation Program in Pennsylvania.
“A healthy sex life, a healthy intimate life, is an important aspect of a normal, healthy existence,” said Alagona, who wasn’t an author of today’s paper, by telephone. “It’s good physically, it’s good emotionally. What we need to encourage people to use is common sense.”
How quickly someone with heart disease can resume having sex after an event like a heart attack or surgery depends on the severity of their condition, Levine said. A person who had a small heart attack or one episode of chest pain may be able to resume sexual activities within a week, while someone who had a heart attack that required surgery will have to wait longer, he said.
Current treatments for heart disease very rarely cause sexual dysfunction, Levine said. He urges patients to take their medicines as prescribed.
Men who have stable heart disease can take medicines to treat erectile dysfunction, which include New York-based Pfizer Inc. (PFE)’s Viagra and Indianapolis-based Eli Lilly & Co.’s Cialis. The erectile treatments shouldn’t be given to patients who are taking nitrates for chest pains from coronary artery disease, according to the statement.
The report also found that women who have heart disease should talk to their doctors about pregnancy and birth control. Pregnancy can cause changes in a woman’s body that could affect her heart disease and certain treatments may harm the fetus, the report said.
The scientific statement provides needed guidelines to help doctors advise patients with heart disease, said Marian Calfa, a cardiologist at Jackson Memorial Hospital in Miami.
“We have guidelines and scientific statements in most of the areas of cardiovascular disease,” said Calfa, who wasn’t an author on today’s paper, in a Jan. 13 telephone interview. “This was a missing piece in our portfolio.”
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