Sexual activity beneficial to cardiac patients

Sexual intimacy is an important quality of life issue for most adults. However, many cardiac patients have concerns both about the health effects of post-myocardial infarction (MI) sexual activity as well as concerns about sexual function. In an article published in this journal, 205 cardiac patients reported that sexual concerns were very common and often included concerns about both intercourse and non-intercourse activities, such as hugging/ kissing and oral sex.1 Another recent paper in EJCN reported that 80% of 128 MI patients were sexually active in the first year after MI and most of these patients were satisfied with their intimate relationship.2 Other studies have reported high levels of both male and female sexual dysfunction following MI or other cardiac events. One study reported significant erectile dysfunction in 186 of 401 men (48.6% – average age of men was 53 years) with angiographically documented coronary heart disease.3 Post MI sexual activity is generally considered safe for patients who are hemodynamically stable and able to undergo gentle exertion (such as walking a block).4 Less than 1% of acute MIs are related to sexual activity.4 The estimated acute risk of MI associated with 1 hour of sexual activity per week is estimated to be 2 to 3 per 10,000 person years.4 Sexual activity also potentially offers important benefits, including lower mortality rates, lower overall incidence of cardiac events and lower rates of depression. Preliminary research suggests that sexual activity is beneficial in preventing and treating heart disease. A large study of 1165 middle-aged, US men without initial cardiovascular disease reported that risk of cardiovascular disease was significantly higher in men who had sexual activity less than once per month as compared to two or more times week (Hazard Ratio (HR) 1.45%, 95% confidence intervals (CI) 1.04–2.01).5 Another large study of 2187 Spanish men (mean age 49.9 years) reported that increased frequency of sexual intercourse was associated with significantly lower risk of major adverse cardiovascular events.6 A study of 1879 MI patients (1274 men and 605 women) reported that patients who resumed sexual activity within 1 month of their MI had a 49% lower risk of all-cause mortality in the first year after MI as compared to patients who did not have sex within the first month (2.1% vs. 4.1%, p=0.08).7 When adjusted for pre-acute MI physical function, the patients who did not resume sexual activity within 1 month had an almost doubled risk for first-year mortality, although this relationship did not reach statistical significance (HR 1.86, 95% CI of 0.80–4.35, p=0.15).7 Sexual activity might also be helpful in preventing/ treating depression in older patients and/or patients with chronic health conditions. Sexual activity seems to fight depression in both women and men and both married and unmarried people. Sexual intimacy seems to be especially helpful in relationships that include emotional support and several kinds of physical affection in addition to penile–vaginal intercourse. A large US study of 2596 adults aged 57–85 years reported that regular sexual activity (which included forms of physical intimacy in addition to intercourse) was associated with significantly lower rates of depression in both women and men.8 This study was large, statistically robust and corrected for such factors as age, health status and socioeconomic factors. Much more clinical and research attention is needed to exploit the healthful effects of sexual activity on MI and other patients. Clinicians should also ask their cardiac patients questions about sexuality and encourage healthful intimate relationships. Clinicians should also provide appropriate medical treatment for sexual dysfunctions (such as erectile dysfunction or loss of libido) of post-MI patients. Nurses often play the key role in holistic care of cardiac patients. Good post-MI care should involve broad-based support, including proper medication, good nutrition, moderate exercise, sufficient sleep, avoidance of toxins such as smoking and pesticides, social and religious support and sexual/emotional intimacy.