Sexual activity and cardiovascular disease

  • Melvin D Cheitlin
    Address for reprints: Melvin D. Cheitlin, MD, Department of Medicine, Box 0846, SFGH 5G1, University of California, San Francisco, San Francisco, California 94143, USA.
    Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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      Cardiovascular disease and erectile dysfunction (ED) are frequently comorbid. Therefore, it is important to consider the risk of renewed sexual activity after successful treatment of ED in men with cardiovascular disease. This article reviews the limited existing knowledge of the metabolic and cardiovascular demands of sexual activity. Evidence suggests that there is a small increase in cardiovascular risk related to sexual activity. Overall, however, the metabolic and cardiovascular demands of sexual activity are modest, and regular physical activity can almost eliminate the increase in risk occurring during sex. In addition, it is unlikely that any direct effect of a phosphodiesterase 5 inhibitor increases cardiovascular risk in patients with cardiovascular disease, absent the coadministration of organic nitrates.
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        • Hellerstein H.K.
        • Friedman E.H.
        Sexual activity and the postcoronary patient.
        Med Aspects Hum Sex. 1969; 3: 70-96
        • Masters W.H.
        • Johnson V.E.
        Human Sexual Response.
        Little Brown & Co, Boston1966
        • Benet A.E.
        • Melman A.
        The epidemiology of erectile dysfunction.
        Urol Clin North Am. 1995; 22: 699-709
        • Miller T.A.
        Diagnostic evaluation of erectile dysfunction.
        Am Fam Physician. 2000; 61: 95-104
        • Taylor Jr, H.A.
        Sexual activity and the cardiovascular patient.
        Am J Cardiol. 1999; 84: 6N-10N
        • Bohlen J.G.
        • Held J.P.
        • Sanderson O.
        • Patterson R.P.
        Heart rate, rate-pressure product, and oxygen uptake during four sexual activities.
        Arch Intern Med. 1984; 144: 1745-1748
        • DeBusk R.F.
        Evaluating the cardiovascular tolerance for sex.
        Am J Cardiol. 2000; 86: 51F-56F
        • Jetté M.
        • Sidney K.
        • Blümchen G.
        Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity.
        Clin Cardiol. 1990; 13: 555-565
      1. Pollock M.L. Schmidt D.H. Heart Disease and Rehabilitation. 3rd ed. Human Kinetics Publishers, Champaign, Ill1996: 372
        • Muller J.E.
        • Mittleman M.A.
        • Maclure M.
        • Sherwood J.B.
        • Tofler G.H.
        Triggering myocardial infarction by sexual activity.
        JAMA. 1996; 275: 1405-1409
        • Maclure M.
        The case-crossover design.
        Am J Epidemiol. 1991; 133: 144-153
        • Anderson K.M.
        • Odell P.M.
        • Wilson P.W.F.
        • Kannel W.B.
        Cardiovascular disease risk profiles.
        Am Heart J. 1990; 121: 293-298
      2. Anderson KM, Wilson WP, Odell PM, Kannel WB. An updated coronary risk profile: a statement for health professionals. Circulation 1991;83:356–362

        • Moss A.J.
        • Benhorin J.
        Prognosis and management after a first myocardial infarction.
        N Engl J Med. 1990; 322: 743-753
        • Stein R.A.
        The effect of exercise training on heart rate during coitus in the post myocardial infarction patient.
        Circulation. 1977; 55: 738-740
        • Drory Y.
        • Shapira I.
        • Fisman E.Z.
        • Pines A.
        Myocardial ischemia during sexual activity in patients with coronary artery disease.
        Am J Cardiol. 1995; 75: 835-837
        • Jackson G.
        Sexual intercourse and angina pectoris.
        Int Rehabil Med. 1981; 3: 35-37
        • Drory Y.
        • Fisman E.Z.
        • Shapira Y.
        • Pines A.
        Ventricular arrhythmias during sexual activity in patients with coronary artery disease.
        Chest. 1996; 109: 922-924
        • Hellerstein H.K.
        • Friedman E.H.
        Sexual activity and the postcoronary patient.
        Arch Intern Med. 1970; 125: 987-999
        • Johnston B.L.
        • Fletcher G.F.
        Dynamic electrocardiographic recording during sexual activity in recent post-myocardial infarction and revascularization patients.
        Am Heart J. 1979; 98: 736-741
        • Ueno M.
        The so-called coition death.
        Jpn J Leg Med. 1963; 17: 330-340
      3. American Heart Association. 1995 Heart and Stroke Statistical Update. Dallas, Tex: American Heart Association, 1995

      4. Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE, for the Determinants of Myocardial Infarction Onset Study Investigators. Triggering of acute myocardial infarction by heavy physical exertion: protection against triggering by regular exertion. N Engl J Med 1993;329:1677–1683

        • Mittleman M.A.
        • Glasser D.B.
        • Orazem J.
        • Collins M.
        Incidence of myocardial infarction and death in 53 clinical trials of Viagra (sildenafil citrate).
        J Am Coll Cardiol. 2000; 35 (Abstract 807-6): 302A
      5. Cheitlin MD, Hutter AM Jr, Brindis RG, Ganz P, Kaul S, Russel RO Jr, Zusman RM. Use of sildenafil (Viagra) in patients with cardiovascular disease: ACC/AHA Expert Consensus Document. Circulation 1999;99:168–177

        • Smith G.D.
        • Frankel S.
        • Yarnell J.
        Sex and death.
        BMJ. 1997; 315: 1641-1644
        • Webb D.J.
        • Freestone S.
        • Allen M.J.
        • Muirhead G.J.
        Sildenafil citrate and blood-pressure–lowering drugs.
        Am J Cardiol. 1999; 83: 21C-28C