SEX LIFE OF PATIENTS WITH CARDIOVASCULAR DISEASE

Abstract

Introduction: Sexual activity is an important component of quality of life being a big concern for both patients with cardiovascular disease and their doctors. There is a concern that sexual activity may cause some major cardiac event, which may lead to an eviction of it. In these patients, due to their risk factors, is also common the presence of sexual disfunction.
Objetives: Review of the scientific literature on properties of sexual activity in patients with cardiovascular disease.
Methods: Classic review of the scientific literature based on review papers published in the last decade, both in english and in portuguese, on Pubmed, Cochrane Lybrary and UpToDate, using MeSH terms: sexual activity and cardiovascular disease.
Results: The perception of a high cardiac workload and risk associated with sexual intercourse was reinforced by the observations that patients with stable angina often noted chest discomfort during or immediately after intercourse. During the intercourse, there is a rise in heart rate and in blood pressure, likewise of any kind of physical exercise. In “real life conditions”, where it was measured sexual activity among couples in their homes, it was registered a medium heart rate of 117 ppm and a medium blood pressure of 162/89 mmHg at climax. The use of medical drugs could prevent the symptoms in these patients and provide a normal sexual life. In order to determinate the risk of myocardial infarction following sex, there was perfomed some several case-crossover studies with similar results. They shown that sexual activity may be considered a trigger to myocardial infarction, but in a transient way. Sexual activity is a temporary trigger that rises the risk of infarction for a period of about 2 hours, being minimum its absolute risk value. Based on these studies, a 50-year-old man free of cardiac disease with an annual baseline risk of MI of 1percent would increase his annual risk of MI to only 1.01 percent from weekly sexual activity. Sexual performance is an important component of quality of life and personal wellbeing. The prevalence of sexual dysfunction, especially erectile dysfunction in men, is higher in those with cardiovascular disease (CVD) than in the general population. The PDE-5 inhibitors are widely used in the treatment of erectile dysfunction in men. An important limitation of this drug family is that they should not be used with nitrates, both in regular or in intermitent way. The simultaneously of PDE-5 inhibitors with nitrates could lead to severe hypotension and syncope. In contrast, PDE-5 inhibitors are tipically well tolerated with the majority of antihypertensive drugs, presenting just a slight reduction of blood pressure levels.

Discussion: Sexual activity is related to a moderate hemodynamic stress and incresases the risk of heart attack. However, their absolute risk is minimum and can be decreased. Patients with cardiovascular disease should be able to have a normal sex life, not forgetting periodic medical reviews.