Sex ruled safe for heart patients

Good news: sex is safe for most heart patients - if you can walk up two flights of stairs without chest pain or gasping for breath.

That is the advice from a leading doctors' group which has addressed one of the most pressing, least discussed issues facing survivors of heart attacks and other heart patients.

In its first science-based recommendations on the subject, the American Heart Association says having sex raises only slightly the chance for a heart attack - and that is the same for people with and without heart disease.

Surprisingly, despite the higher risk for a heart patient to have a second attack, there is no evidence that they have more sex-related heart attacks than people without cardiac disease.

Many heart patients do not think twice about climbing stairs, yet many worry that sexual activity will cause another heart attack, or even sudden death, said Dr Glenn Levine, lead author of a report detailing the recommendations and a professor of medicine at Baylor College of Medicine in Houston, Texas.

The report says sex is something doctors should bring up with all heart patients. Yet few do because they are uncomfortable talking about it or they lack information, Dr Levine said. The new guidance is designed to fill that gap.

Heart patients should get the go-ahead from a doctor before engaging in sexual activity. Many may be advised first to do cardiac rehab - exercise while being monitored for heart symptoms, to improve heart strength and increase physical fitness. But the heart association says most will eventually be cleared to resume sexual activity.

The doctors' group offers advice for heart patients based on scientific research involving sometimes provocative sex-related topics:

:: Who is most at risk for sudden death related to sex? Married men having affairs, often with younger women in unfamiliar settings. Those circumstances can add to stress that may increase the risks, evidence from a handful of studies suggests;

:: Sex may be OK as soon as one week after a relatively mild heart attack, if patients can walk up a few flights of stairs without discomfort;

:: Viagra and other drugs for erectile dysfunction are generally safe for men with stable heart disease.

"The risk of having a heart attack during sexual activity is two to three times higher than when not having sexual activity. However, this increased risk of heart attack during sexual activity represents only a very small part of a person's overall risk of having a heart attack, and sexual activity is the cause of less than 1% of all heart attacks," Dr Levine said.

Among heart attack survivors, average risks for another heart attack or sudden death are about 10 in one million an hour; having sex increases that to about 20 to 30 in one million per hour of sexual activity, the new report says. People without heart disease face lower overall risks for a heart attack, but similar risks for a sex-related attack.

The updated advice was released online in the heart association journal Circulation.

Dr Keith Churchwell, chief medical officer of Vanderbilt University's Heart and Vascular Institute, said the guidance was important for patients and that questions about sex were the most common ones he heard from heart patients.

Ohio State University heart specialist Martha Gulati praised the recommendations for emphasising that sexual counselling is important not just for patients but also their partners, who she says are often just as nervous about resuming sexual activity.

Chicago cardiologist Dan Fintel, a professor of medicine at Northwestern University, said he routinely gave heart patients a sex talk on their last day in the hospital, knowing that it was most likely on their minds.

"Resuming sexual activity is safe and emotionally part of the healing process, with a few caveats," he tells patients.

Those caveats elicit nervous chuckles when he explains that includes no philandering, given evidence about that causing extra stress.