Sexual activity safe for most CVD patients

Most patients with cardiovascular disease (CVD) can safely engage in sexual activity, according to a new scientific statement from the American Heart Association.

A multidisciplinary group of experts developed the evidence-based statement to synthesize and summarize existing data into recommendations and foster communication between clinicians and patients about sexual activity. The statement specifically addresses several different conditions, including coronary artery disease, heart failure, valvular heart disease and arrhythmias.

In general, the experts concluded that patients with stable symptoms and good functional capacity have low risk of cardiovascular events from sexual activity (Class IIa, Level of Evidence B recommendation). Any patients with unstable or severe symptoms should be stabilized before sexual activity (III, C). To determine which category a patient falls into, a comprehensive history and physical is reasonable before a physician provides a recommendation (IIa, C). If a patient's risk is uncertain after examination, exercise testing can be useful (IIa, C).

Cardiovascular drugs that can improve symptoms and survival should not be withheld because of concerns about sexual function, the statement said (III, C). Recent data do not show clear relationships between most of these drugs and erectile dysfunction. For patients who do have sexual dysfunction and stable CVD, PDE5 inhibitors can be useful (I, A). However, the drugs are absolutely contraindicated in patients taking nitrates (III, B).

Physicians should assess anxiety and depression regarding sexual activity in their CVD patients, the statement recommended (I, B). They should also counsel both the patient and spouse or partner about sexual activity following an acute cardiac event, new CVD diagnosis or ICD implantation (I, B). Suggestions to the patient for making activity safer could include “being well rested at the time of sexual activity, avoiding unfamiliar surroundings and partners to minimize stress during sexual activity, avoiding heavy meals or alcohol before sexual activity, and using a position that does not restrict respiration.”

The statement was 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. It was published online by Circulation on Jan. 19.