Published June 30, 2005
Important new research shows that many heart patients with erectile dysfunction may be able to safely stop taking the heart medication that makes them ineligible for erectile dysfunction drugs.
A sexual medicine specialist calls the findings "groundbreaking," and a noted cardiologist says there is a growing appreciation for the importance of offering heart patients treatment options that make sex possible.
"The answer to the question, 'Can patients with heart disease safely have sex?' is almost always 'Yes,' unless they have such bad heart failure or severe artery disease that even a moderate amount of exertion will cause terrible chest pain," says Richard Stein, MD, who is director of preventive cardiology at New York City's Beth Israel Hospital. "And if that is the case, sex is probably the last thing on their minds anyway."
Nitrates and Erectile Dysfunction Drugs Don't Mix
Impotence is common among men with heart problems. So common, in fact, that erectile dysfunction is increasingly being recognized as an early warning sign for heart disease.
Heart patients are often treated with drugs called oral nitrates, such as Nitro-Dur and Isordil, in addition to other medications.
Men on nitrates cannot take erectile dysfunction drugs like Viagra, Levitra, or Cialis because the combination can cause dangerous drops in blood pressure.
In the newly reported study, London cardiologist Graham Jackson, MD, and colleagues wanted to find out if men with erectile dysfunction and stable heart disease could safely stop taking nitrates to allow for safe use of an erectile dysfunction drug.
They defined stable heart disease as a man with no significant exercise limitations (for example, they could walk 1 mile on flat ground without stopping). In addition, the men needed nitroglycerin under the tongue less than once a month for chest pain.
No Chest Pain When Nitrates Stopped
The researchers studied 55 men who were considered good candidates for stopping nitrates following exercise stress tests.
All the men taken off nitrates were taking low-dose aspirin along with other heart drugs. Only three of the men had an increase in heart symptoms a week after discontinuing their oral nitrates. More than 90 percent of these men began taking an erectile dysfunction drug, and 85 percent of those followed for three months or more reported restored sexual function.
The men taking the erectile dysfunction drugs reported no increase in chest pain or heart attacks after three months. The findings are reported in the July issue of The Journal of Sexual Medicine.
Irwin Goldstein, MD, who is editor-in-chief of the journal, tells WebMD that restoring sexual function to men who desire sexual activity is a quality-of-life issue that has been too long ignored.
He called the study a "huge, groundbreaking advance."
We now know that oral nitrates can be stopped while continuing other heart disease treatments in stable men with stable heart disease to allow for the safe use of ED drugs, he says.
Jackson tells WebMD that the findings have implications for all heart patients taking oral nitrates, not just men who want to take impotence drugs.
"Nitrates do not prevent heart attacks and they don't lengthen life," he says. "They are purely for symptoms, so why are so many people without symptoms taking them?"
Stein, who is a spokesman for the American Heart Association, says heart patients need to be taken off nitrates slowly and then evaluated carefully to determine if they are strong enough for sexual activity.
He says men who don't experience an increase in chest pain when they discontinue nitrates and perform well on exercise stress tests are probably good candidates for erectile dysfunction drugs.
"Patients who are interested in sexual activity need to ask their doctor if they really need to be on nitroglycerine," he tells WebMD. "If their doctor dismisses the question, maybe they should find another doctor."
SOURCES: Jackson, G. The Journal of Sexual Medicine, July 2005; vol 2: pp 513-516. Graham Jackson, MD, cardiologist, Cardiothoracic Centre, St. Thomas' Hospital, London. Richard Stein, MD, professor of clinical medicine, Albert Einstein College of Medicine; director of preventive cardiology, Beth Israel Hospital, New York City; spokesman, American Heart Association. Irwin Goldstein, MD, editor-in-chief, The Journal of Sexual Medicine.