Sexual activity cardiovascular disease

Moderate risk Has three or more risk factors for coronary artery disease Has moderate, stable angina Had a recent myocardial infarction or stroke within the past 6 weeks Has moderate congestive heart failure (NYHA Class 2) Fbtient should undergo a complete cardiovascular work-up and treadmill stress testing to determine tolerance to increased myocardial energy consumption associated with increased sexual activity... 

Sildenafil and vardenafil decrease systolic/diastolic blood pressure by 8 to 10/5 to 6 mm Hg for 1 to 4 hours after a dose. Although most patients are asymptomatic, multiple antihypertensives, nitrates, and baseline hypotension increase the risk of developing adverse effects. Although tadalafil does not decrease blood pressure, it should be used with caution in patients with cardiovascular disease because of the inherent risk associated with sexual activity. 

Further, ginseng constituents are polysaccharides, essential oil constituents, polyacetylenes, peptides, and other lipids (7). Ginseng is included in the pharmacopeias of several countries such as China, Germany, and the United Kingdom (113). Modern therapeutic claims refer to vitality, immune function, cancer, cardiovascular diseases, and sexual function (114,115). More than 500 studies have been published on the pharmacological activity of ginseng (7,80). 

Cordyceps sinensis Link. Dong Chong Xia Chao (fruit body) 2 -deoxyadenosine, adenosine, sterols, saccharides, protein, cordycepin, d- mannitol 33,91,92,401,402,412,413,414,459 Lead poisoning was reported.238 Antisenescence, hypolipidemic, endocrine, antitumor, antiatherosclerotic and sexual function-restorative activities. Treat respiratory, renal, liver and cardiovascular diseases, antileukemic cells, hyposexuality, and hyperlipidemia. 

There is no evidence that treating ED in patients with cardiovascular disease increases cardiac risk however, this is with the proviso that the patient is properly assessed and the couple or individual (self-stimulation may be the only form of sexual activity) are appropriately counselled. Oral drug therapy is the most widely used because of its acceptability and effectiveness, but all therapies have a place in management. The philosophy is to always be positive during what, for many men and their partners, is an uncertain time. 

T ble 4 Risk from sexual activity in cardiovascular diseases Second Princeton Consensus Conference... 

ED is common in patients with cardiovascular disease and should be routinely enquired about. The cardiac risk of sexual activity in patients with cardiovascular disease is minimal in properly assessed patients. The restoration of a sexual relationship is a possibility for the majority of patients with cardiovascular disease and ED using oral PDE5 inhibitors, which have an excellent safety profile (avoiding nitrate use). ED is a marker for cardiovascular disease as well as its consequence therefore, its identification (in the asymptomatic male) provides the opportunity to address other cardiovascular risk factors and detect silent but significant vascular pathology. 

The interpretation of these sporadic cases is controversial, although some have argued that the reported cardiovascular adverse effects occur more often with sildenafil than with other pharmacological treatments of erectile dysfunction. It is at present unclear whether there is an increased risk with sildenafil. For example, in placebo-controlled trials there have been no differences in the incidences of myocardial infarction, angina, or coronary artery disorders between sildenafil and placebo (9). Exclusion criteria in clinical trials may have prevented the inclusion of patients who are at increased risk of adverse events. On the other hand, sexual activity itself increases cardiac workload and the risk of myocardial infarction. Patients with cardiovascular disease should be cautious in their use of sildenafil. 

There has been debate on the risk of death after sildenafil can it be entirely attributed to co-existing cardiovascular disease with an inherent high risk of mortality, particularly during sexual activity, or does the drug contribute (31,32). 

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