Sexual Function in Patients With Chronic Angina Pectoris

Study Questions:

What are the current recommendations for sexual activity in patients with chronic angina?

Methods:

Drugs for erectile dysfunction (ED) may be contraindicated with nitrates commonly used to treat patients with angina pectoris, and certain antianginal therapies may worsen ED. The American Heart Association and the Princeton Consensus Conference panel of experts recommend that patients with coronary artery disease (CAD) and ED who experience angina pectoris undergo full medical evaluations to assess the cardiovascular (CV) risks associated with resuming sexual activity before being prescribed therapy for ED, and be able to exercise for 3-5 METs without angina. For uncomplicated myocardial infarction, sexual activity is reasonable >1 week after attack if the patient is without cardiac symptoms during mild to moderate physical activity. Sexual activity is reasonable for patients who have undergone complete coronary revascularization, and may be resumed several days after percutaneous coronary intervention if the vascular access site is without complications, or 6-8 weeks after standard coronary artery bypass graft or noncoronary open heart surgery, provided the sternotomy is well healed. For incomplete coronary revascularization, exercise stress testing can be considered to assess the extent and severity of residual ischemia. Sexual activity should be deferred for patients with unstable or refractory angina until their conditions are stabilized and optimally managed. Current antianginal therapies include beta-blockers, calcium channel blockers, short- and long-acting nitrates, and ranolazine, a late sodium current inhibitor. Short- and long-acting nitrates remain a contraindication with phosphodiesterase-5 (PDE-5) inhibitors commonly used to treat patients with ED, and the benefits of the other antianginal therapies must be weighed against their effects on CV health and erectile function. Patients with CAD and ED who wish to initiate PDE-5 inhibitor therapy and need to discontinue nitrate therapy need treatment options that manage their angina pectoris effectively, maintain their CV health, and provide the freedom to maintain their sexual function.

Conclusions:

The authors concluded that the contraindication for concomitant use of nitrates with PDE-5 inhibitors complicates therapy for men with CAD who may experience ED and angina. These patients may benefit from being switched from nitrates to antianginal therapies that do not adversely affect CV health and sexual function. However, common alternatives such as beta-blockers and calcium channel blockers may impair erectile function, and there is a need for alternatives that maintain CV health with minimal impact on erectile function in men who experience CAD and ED. More study is needed to evaluate the effect of switching patients taking nitrates who wish to use PDE-5 inhibitors to other antianginal therapies that are not contraindicated with PDE-5 inhibitors and that do not exacerbate CV risk in patients with CAD and ED.

Perspective:

The paper summarized the current literature and guidelines regarding sexual function in cardiac patients. This information should be discussed with cardiac patients, as the majority of patients have questions about their sexual health.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease

Keywords: Sexual Behavior, Coronary Artery Disease, Myocardial Infarction, Phosphodiesterase 5 Inhibitors, Piperazines, Calcium Channel Blockers, Percutaneous Coronary Intervention, Erectile Dysfunction, Nitrates, Motor Activity, Cardiac Surgical Procedures, Coronary Artery Bypass


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