Most people with heart disease can safely engage in sexual activity. So says the American Heart Association in a new scientific statement, the first time the group has addressed the subject of cardiovascular disease and sex.

The AHA statement, which is based on the recommendations of experts in heart disease, exercise physiology and sexual counseling, notes that after a diagnosis of cardiovascular disease, it is reasonable for patients to be evaluated by their physician or health care provider before resuming sexual activity.

Having sex is comparable to mild to moderate exercise such as brisk walking or climbing several flights of stairs.

The statement also makes clear that individuals with unstable or severe heart disease, including those who have symptoms upon minimal activity or while at rest, should refrain from sexual activity until their condition is stabilized with appropriate treatment.

But for the majority of cardiovascular patients – those with stable disease – there is no need to put one's sex life on hold. Yet many patients, or their mates, are reluctant to engage in sex after learning of a cardiovascular condition out of fear of triggering an acute attack or even death. According to Dr. Glenn Levine, lead author of the statement and a professor of medicine at Baylor College of Medicine in Houston, sexual activity is a major quality of life issue for men and women with cardiovascular disease and their partners, and it's important to help couples overcome undue fear about engaging in sex.

The truth is that the risk of having a heart attack during sex is minuscule. In most cases, Dr Levine notes, having sex is comparable to mild to moderate exercise such as brisk walking or climbing several flights of stairs. The risk of cardiac death is even lower. In fact, a person with cardiovascular disease is much more likely to die while playing golf than while having sex. In those very rare cases when sex-related cardiac death occurs, 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.

Nevertheless, it is common for men and women with cardiovascular disease to experience a decrease in sexual interest or activity. Although sexual dysfunction can stem from the underlying cardiovascular disease, it is more often related to anxiety and depression.

The AHA statement adopts a positive view of sex as part of a plan to resume a normal life. The statement also stipulates that heart and stroke patients need not necessarily avoid drugs to enhance sexual enjoyment, although the statement makes clear that such drugs should not be used by everyone. Drugs to treat erectile dysfunction are generally safe for men who have stable cardiovascular disease. However, these drugs are dangerous when used together with nitrate drugs for chest pain, and should not be used by men who take nitrates.

For post-menopausal women with cardiovascular disease, the AHA statement concludes that the use of topically or vaginally inserted estrogen to treat painful intercourse is acceptable.

Although many patients may be concerned about resuming sexual activity, they are often embarrassed to broach the subject with their doctor. "Some patients will postpone sexual activity when it is actually relatively safe for them to engage in it," Dr. Levine noted. "Unfortunately, discussions about sexual activity rarely take place in the clinical context."

If you are anxious about engaging in sexual activity after a stroke or cardiac event, you are not alone. But you likely needn't worry. Discuss the matter with your doctor. You may well be surprised at the reassurance and encouragement you receive.

For those who want more information, the AHA offers a patient pamphlet about sex and heart disease. Copies can be obtained through the organization's website.