Healthy Living News

Sex Called Safe for Most Heart Patients

by Mary Pickett, M.D.
Harvard Medical School

Most heart patients are healthy enough to have sex, the American Heart Association (AHA) says. In a new statement, the group tries to clear up questions about what's known about sex and heart disease. Heart patients should ask a doctor if they can safely have sex. Some may need heart rehab first. But most eventually get the doctor's OK, even after a heart attack. Generally, the AHA says, if you can climb two flights of stairs without chest pain or gasping for breath, you can have sex. The risk of having a heart attack is two to three times higher during sex. But that's still only a slight increase in a person's overall heart attack risk, the AHA says. Only about 1% of heart attacks are caused by sex. Research suggests that the risk of sudden death from sex is greatest for a married man having an affair with a younger woman in an unfamiliar place. All of those extra factors beyond the sex itself increase the stress, the AHA says. Viagra and other impotence drugs are OK for most men with stable heart disease. The Associated Press wrote about the new statement.

What Is the Doctor's Reaction?

Hearts and sweethearts are good together. This week the American Heart Association (AHA) is talking about sex -- not in whispers, but in a scientific statement.

For most people who have heart disease, it is safe to have sex. But would you have known this? If not, would you have had the resolve to ask your cardiologist? It is a welcome bit of outreach that the AHA has made a point to summarize what we do know about sex and heart disease.

Here is the punch line: Sex is exercise. Blood pressure and heart rate both go up during sex. The "cardio" workout that comes with sex can vary. But for married couples who have been wired to home monitors, it is roughly the same as a moderately paced or brisk walk on a flat surface.

Is it possible for sex to trigger a heart attack? In theory, yes. Sometimes rigorous exercise, anger or sex creates enough stress and strain that a heart attack can follow. But an extraordinarily small number of heart attacks start this way. And the increase in heart attack risk from sex is very small.

Let's put some numbers on it. Let's say you have a high risk of having a heart attack in the next year. For example, let's assume you have already had one heart attack and you rarely or never exercise. Experts would say that you have a 10% chance of another heart attack in the next year. In this scenario, adding sex once a week would increase your risk to about 10.1% per year.

But what if you adopted good exercise habits and become physically fit? (This would mean exercising for at least 30 minutes on 4 days of the week.) Then your risk of a heart attack would be closer to 3% each year, with sex or without it.

There are exceptions. If you have heart disease, read the next section to make sure that sex is safe for you.

What Changes Can I Make Now?

Some people with heart disease should get their doctors' go-ahead before restarting sex. Sex is unsafe for the following conditions:

• Symptoms of angina -- For people who have angina (chest pain or pressure) from artery disease, exercise -- or sex -- can result in symptoms. Angina is a sign that the heart is not getting enough oxygen. This is not healthy, whether the cause is sex or other exercise. If you have chest pain during sex, you need to see a doctor. If your heart's blood supply can be improved with medicines, a catheter procedure or surgery, then it is safe to resume sex (and exercise).
• Very recent heart attack -- Do not have sex for the first two weeks after a heart attack.
• Some heart valve problems -- People who have been diagnosed with aortic valve stenosis should talk with their doctors about whether it is safe to have sex.
• Heart failure with symptoms -- Heart failure can get worse if the heartbeat is allowed to race or the blood pressure rises.

Special notes for women:

• Pregnancy may not be safe if you have heart disease. During pregnancy, the heart pumps much more blood. This can make some heart problems more significant during pregnancy. Speak with your doctor if you have heart disease and you are thinking about becoming pregnant.



• Estrogen increases heart attack risk. If you have a history of angina or heart attack, estrogen could increase your heart risk. This is important for women who have heart disease at a young age. It means that birth control pills may not be the best choice for preventing pregnancy. It is also important information for women after menopause. Hormone replacement treatment (estrogen, combined with progesterone) nearly doubles heart attack risk.

Special notes for men:

• Some medicines cause impotence as a side effect. This is especially common with beta-blocker medicines, diuretics ("water pills") and cholesterol medicines. All of these are commonly used in heart disease treatment. Talk with your doctor about whether a different medicine can be used. Do not stop medicines without your doctor's advice.



• Impotence drugs do not mix with nitroglycerin. Viagra, Levitra, Cialis and similar impotence drugs can cause low blood pressure if they are used along with heart medicines known as nitrates. Nitroglycerin is a nitrate. So are isordil (isosorbide dinitrate) and Nitropaste. You should wait at least 48 hours after use of nitrates before using impotence medicines.

What Can I Expect Looking to the Future?

I hope that the AHA statement will help heart patients to feel more comfortable in asking their doctors questions related to sex. Your doctor will not be surprised that you asked.

Categories: Heart Health

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