Risk to Individual Patient 'Extraordinarily Low'
By Salynn Boyles
WebMD Health News
Reviewed by Laura J. Martin, MD
Jan. 19, 2012 -- Most patients can safely resume sexual activities one week after having an uncomplicated heart attack, according to a new report from the American Heart Association.
The report represents the most comprehensive review of the research on sex in heart patients ever conducted by the group, and it is intended to help patients and their doctors discuss the subject.
Among the main findings:
- Sexual activity is safe for most heart patients with stable heart disease.
- Drugs used to treat erectile dysfunction are generally safe for men with stable heart disease unless they are taking nitrates for chest pain. Nitrates should never be used within 24 to 48 hours of using an erectile dysfunction drug.
- Patients with severe heart disease who experience chest pain (angina) or other symptoms with minimal or no activity should refrain from sex until their symptoms are stabilized with treatment.
"Patients may be nervous about asking their doctor about sex," says researcher Glenn N. Levine, MD, professor of medicine at Baylor College of Medicine.
"There is a misperception that many patients with heart disease should not have sexual relations," he says. "This is in part due to the rare, sensationalized cases of politicians and other celebrities dying during sex."
Heart Attacks, Death During Sex Very Rare
The research review confirmed that these widely publicized cases are very much the exception and not the norm.
Sexual activity was found to be the cause of less than 1% of all heart attacks and less than 1% of all cases of sudden death related to heart ailments or stroke.
Having sex was associated with a two- to threefold increase in heart attack risk among heart patients, but Levine characterizes the risk to the individual patient as "extraordinarily low."
"It is important to remember that the vast majority of heart attacks occur when people are not having sex," he says.
In one autopsy study involving 5,559 people who died suddenly from heart arrhythmias (a disruptive heart rhythm), just 34 (0.6%) of the deaths reportedly occurred during sexual activity. Two other studies reported similarly low rates of sudden death associated with sex.
Most of these cases occurred in men, and three out of four of these deaths involved extramarital sex, most often with a younger partner in an unfamiliar setting.
"One could speculate that higher anxiety or higher adrenaline might have been involved in these deaths, but because the numbers were so small I wouldn't want to read too much into this," Levine says.
Chest pain associated with sexual activity, known medically as coital angina, was also uncommon, accounting for less than 5% of all angina attacks.
So When Is It OK to Have Sex?
The AHA statement also addressed how long patients should wait before having sex after a heart-related event, concluding that:
- Heart attack patients can generally resume sexual activity one week after the event, unless there are complications such as heart symptoms during mild to moderate physical activity.
- It is generally safe for patients who have had uncomplicated angioplasty procedures to have sex within a few days. Patients who have heart bypass surgeries or other open-heart surgery can generally resume sexual activity within six to eight weeks.
Among the other findings and recommendations:
- Decreased sexual function, which is common in heart patients, is often related to anxiety and depression and is not commonly caused by heart disease medications.
- It is reasonable for patients with a new diagnosis of heart disease to be evaluated by their health care provider before resuming sexual activity.
- Heart rehabilitation and regular exercise can reduce the risk of heart complications related to sexual activity in people who have had a heart attack or heart failure.
- Premenopausal women with heart disease should be counseled on the safety of contraceptive methods and pregnancy.
Report Should Reassure Heart Patients
Boston cardiologist Jeffrey Kuvin, MD, says the AHA report should reassure patients and their health care providers.
"Sex is generally safe for heart attack patients and for those with many other conditions, including congestive heart failure, congenital heart disease, and heart arrhythmias," he says.
Kuvin is associate chief of the division of cardiology at Tufts University Medical Center.
"The general rule is that if patients can engage in moderate exercise -- such as walking up a couple of flights of stairs -- without causing heart symptoms, they are probably healthy enough for sex," Kuvin says.
Since anxiety and depression are common causes of sexual dysfunction in heart patients, the AHA recommends counseling for such patients.
"Sexual counseling of [heart] disease patients and their partners is an important component of recovery; unfortunately, it is rarely provided," the report concludes.
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