THURSDAY, Jan. 19 (HealthDay News) -- Sexual activity generally isn't hazardous for people with cardiovascular disease, the American Heart Association says in a new statement.

But patients should get checked by a doctor beforehand and be aware that heart problems could spell trouble in some cases of cardiovascular disease, especially if they're not controlled.

The heart association also cautions that there needs to be more research into how sexual activity affects the cardiovascular system of women and older people who have specific conditions.

"The reality is that in most patients, the risk is low," said Dr. Glenn Levine, a professor of medicine at Baylor College of Medicine and lead author of the statement. "In most patients with stable heart disease, it is reasonably safe to participate in sexual activity, which is probably comparable to mild to moderate physical activity, like walking or going up several flights of stairs."

Heart patients frequently don't mention the risk of sexual activity but it may still be on their minds, Levine said. "We want to encourage health-care professionals to discuss this and encourage patients and partners to bring it up."

The statement authors report that fewer than 1 percent of acute heart attacks are linked to sexual activity. For people who have had a heart attack, engaging in sexual activity increases the risk of another heart attack or death "from 10 chances in 1 million per hour to 20 to 30 chances in 1 million per hour," according to the report.

Research has found that sudden death is extremely rare during sexual activity. But when it does occur, it's almost always in men and mostly in those who are having extramarital sex, "in most cases with a younger partner in an unfamiliar setting and/or after excessive food and alcohol consumption," the statement said.

The statement suggests that certain heart patients avoid sexual activity just like other potentially risky exercise. "Certainly there are some patients who have unstable or severe symptoms," Levine said, "and it's more important for them to be stabilized and treated before they engage in any significant physical activity."

The statement authors also write that sexual activity is "reasonable" for people who suffer from mild angina (chest pains) and those with mild or moderate valvular heart disease and no or mild symptoms. It's also "reasonable" for people whose atrial fibrillation (an irregular heartbeat) is controlled and for those with pacemakers.

Some research has linked heart medications to erectile dysfunction. But the statement says recent research hasn't directly connected modern heart drugs to the condition. "Cardiovascular drugs that can improve symptoms or survival should not be withheld because of concerns about their adverse impact on sexual function," the statement said.

The statement also cautions male heart patients who take nitrates for chest pain to avoid erectile dysfunction drugs. But it's "reasonable" for post-menopausal female heart patients to use topical or vaginally inserted estrogen to treat painful intercourse.

Dr. Reena Pande, a cardiologist at Brigham and Women's Hospital in Boston, said the statement includes plenty of common sense.

"If you're active and asymptomatic [no symptoms], you're OK. If you have frequent chest pain, shortness of breath and palpitations, you should probably not have sex," Pande said. "And if you're in between, your doctor may want to do some tests to help figure out if sex is safe for you."

For doctors specifically, the statement offers helpful guidance about exactly when sexual activity is a good idea, such as six to eight weeks after open heart surgery, she said.

Pande also agrees with the overall message about communication between doctors and patients.

"Talk to your doctor about sex. Your doctor can help you figure out if it's safe or not safe," she said. "We understand it may be an uncomfortable subject, but it's better to bring it up with your doctor now than to put yourself at risk. Communication is critical. We will not know you are having a problem unless you tell us."

The statement was published online Jan. 19 in the journal Circulation.

More information

For more on sexual heath, visit the U.S. National Library of Medicine.