Pillow Talk: First AHA Advice on Sex and CVD

1:05 pm Health Care, Medicine

1. Sexual activity is safe for the majority of heart disease patients, as per new first-ever American Heart Association (AHA) scientific statement published in Circulation by lead author Dr Glenn N Levine (Baylor College of Medicine, Houston, TX).
2. Physicians, patients, and partners are reluctant to talk about sexual activity, but it is something “that is important to quality of life for most people, and we would not want to see patients refraining from sex out of undue concern about precipitating a heart attack or sudden death,”
3. The only patients who should refrain from sex are those with unstable heart disease or severe symptoms; they should be assessed and stabilized with appropriate treatment before engaging in sexual activity.
4. Drugs that can improve cardiovascular symptoms or survival should not be withheld due to concerns that they may have an impact on sexual function.
5. While use of phosphodiesterase-5 (PDE-5) inhibitor erectile-dysfunction drugs, such as sildenafil are generally safe for men who have stable cardiovascular disease, these agents are absolutely contraindicated in patients receiving nitrate therapy, either long-acting preparations or sublingual ones.
6. The risk of heart attack with sexual activity is only extremely modestly increased during sexual activity and represents only a miniscule amount of a person’s overall risk.
7. Another important consideration raised in the AHA statement–which is also endorsed by the American Urological Association, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association of Cardiovascular and Pulmonary Rehabilitation, International Society of Sexual Medicine, American College of Cardiology Foundation, Heart Rhythm Society, and Heart Failure Society of America–is that cardiac rehabilitation and regular physical activity can reduce the risk of cardiovascular complications in people with heart disease.
8. Exercise testing can also provide additional information as to the safety of sexual activity in patients with indeterminate or unclear risk, the authors note.

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