Journal of Invasive Cardiology

DALLAS, Jan. 19, 2012 -- If you have stable cardiovascular disease, it is more than likely that you can safely engage in sexual activity, according to an American Heart Association scientific statement.

The statement, published online in Circulation: Journal of the American Heart Association, contains recommendations by experts from various fields, including heart disease, exercise physiology and sexual counseling.

"Sexual activity is a major quality of life issue for men and women with cardiovascular disease and their partners," said Glenn N. Levine, MD, lead author of the statement and a professor of medicine at Baylor College of Medicine in Houston, Texas. "Unfortunately, discussions about sexual activity rarely take place in the clinical context."

The recommendations include:

-- After a diagnosis of cardiovascular disease, it is reasonable for
patients to be evaluated by their physician or healthcare provider
before resuming sexual activity.

-- Cardiac rehabilitation and regular physical activity can reduce the risk
of cardiovascular complications related to sexual activity in people who
have had heart failure or a heart attack.

-- Women with cardiovascular disease should be counseled on the safety and
advisability of contraceptive methods and pregnancy based on their
patient profile.

-- Patients with severe heart disease who have symptoms with minimal
activity or while at rest should not be sexually active until their
cardiovascular disease symptoms are stabilized with appropriate
treatment.

-- Patients should be assessed to see if their sexual dysfunction is
related to underlying vascular or cardiac disease, anxiety, depression
or other factors.

-- Drugs that can improve cardiovascular symptoms or survival should not be
withheld due to concerns that such drugs may impact sexual function.

-- Drugs to treat erectile dysfunction are generally safe for men who have
stable cardiovascular disease. These drugs should not be used in
patients receiving nitrate therapy for chest pains due to coronary
artery disease (blockages in the arteries that supply the heart with
blood), and nitrates should not be administered to patients within 24-48
hours of using an erectile dysfunction drug (depending on the drug
used).

-- It is reasonable for post-menopausal women with cardiovascular disease
to use estrogen that's topically or vaginally inserted for the treatment
of painful intercourse.

Decreased sexual activity and function -- common in men and women with cardiovascular diseases -- is often related to anxiety and depression.

The absolute rate of cardiovascular events during sexual activity, such as heart attacks or chest pain caused by heart disease, is miniscule because sexual activity is usually for a short time.

"Some patients will postpone sexual activity when it is actually relatively safe for them to engage in it," said Levine, who is also director of the Cardiac Care Unit at the Michael E. DeBakey Medical Center in Houston. "On the other hand, there are some patients for whom it may be reasonable to defer sexual activity until they're assessed and stabilized."