As the first few deaths surface among some 1.3 million people who have taken Viagra, a drug to treat impotence, many patients and physicians are re-examining risks associated with the drug and the activity it has reintroduced for many couples: Sex.
Given the clear connection between impotence and heart disease, the deaths of Viagra patients may seem like a sign that people with such health problems weren’t meant to have sex. But while the danger is real, doctors say some patients can lessen the risk of sexual activity by preparing themselves with such simple measures as physical training.
Some concerns about Viagra have been overblown: Only four of the six deaths nationwide originally reported to the Food and Drug Administration since April have turned out to be men who actually took the drug.
In the fifth confirmed case, a Tinley Park resident who died last Friday while on the drug, the 58-year-old man had serious heart problems before he started taking Viagra, a spokesman for the Cook County medical examiner’s office said Tuesday.
An FDA spokeswoman said no direct link has been found between Viagra and the deaths reported so far, and the agency believes the drug is “safe and effective for its labeled use.” Local officials attributed the Tinley Park man’s death to hardening of the arteries, adding it is impossible to know whether Viagra played a role.
The recent deaths nevertheless highlight the crucial need to give thorough medical screenings to patients who want Viagra, physicians say. But experts also say it’s important to put the risks in perspective.
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“Although there are some well publicized cases, in general, sex is not a really high-risk activity,” said Dr. Lloyd Klein, a cardiologist at Rush-Presbyterian-St. Luke’s Medical Center, Chicago. “The heart rate and blood pressure don’t go as high as they do during other activities such as shoveling snow, running after a bus or having a fight with your spouse.”
And even if the five reported deaths are just a fraction of the actual number of people using Viagra who have died, medical experts say that statistic is well within the expected number of fatalities given the vast group of men who have flocked to take Viagra, the first oral treatment for impotence.
Early hype has lent Viagra the cumbersome trappings of sexual mystery. Yet doctors say that for patients with heart disease–the only group for whom sex is a significant risk–the decision of whether to take the drug and resume sexual activity fits within a broad and familiar spectrum of tradeoffs between health and physical exertion.
Even for people who aren’t on Viagra, the risk of having a heart attack or a stroke during sex grows with age and other risk factors. The chance that a 50-year-old healthy man will suffer a non-fatal heart attack after sex is about 2.5 in a million, according to Dr. James Muller, director of the Gill Heart Institute at the University of Kentucky. The risk may be 1 in 1,000 for a sedentary man with a history of heart disease, Muller said.
But the real risk varies for each individual, Muller said. In addition, sedentary heart patients who want to return to sexual activity can take steps to prepare themselves for the added strain, as they would for any other physical exertion.
“They should enter spring training,” Muller said. “Get in shape– walk, increase physical activity or join a fitness program.”
Even the finer points of sexual technique can determine whether a couple can resume having sex, according to Dr. Allen Anderson, director of the Center for Heart Failure Management at the University of Chicago Hospitals.
“We advise some patients to use positions that are less stressful,” Anderson said. “That way they can continue to enjoy sex without so much physical strain.”
It’s not surprising that heart disease and impotence are linked, since both problems can be traced to poor blood flow. A study released this week by doctors at Loyola University Medical Center, Maywood, found impotence is a good predictor of heart disease.
Impotence drugs such as Viagra, along with many heart medications, work by widening blood vessels and improving circulation. In fact, Viagra was first tested as a drug for treating angina; only by accident did some men in those trials find that their ability to have erections improved.
Now that Viagra has become one of the best-selling prescription drugs in history and a cultural phenomenon, impotence experts and cardiologists are having many delicate conversations with their heart-disease patients. Although sex does not rank high among stressful activities, patients who are extremely sick or follow elaborate treatment regimens cannot afford to indulge in it–a difficult message to relate, physicians say.
“It’s a lot easier to tell someone to give up bowling or sailing,” Rush’s Klein said.
Some of the toughest calls come with patients who take nitroglycerine or similar medications for their heart conditions. Such drugs can interact dangerously with Viagra by widening blood vessels and reducing blood pressure, which can lead to a heart attack.
Viagra’s label warns against taking the drug in conjunction with nitroglycerine-type medications, but Viagra-maker Pfizer Inc. tells doctors that patients can take Viagra if they discontinue the other medications. That move carries risks of its own, according to Klein.
“What is the risk for somebody who needs nitroglycerine but stops taking it so they can have sex?” he said.
The same choices surround other impotence remedies and some hypertension drugs that have impotence as a side effect.
“Most people with heart disease are quite reasonable about it,” Anderson said. “They’ve been sick for years, and they’re out for quality and quantity of life.”
Some of Viagra’s danger may lie very much in the minds of heart patients. The mere mental rush of the event increases adrenaline and makes the heart pump faster.
“The reason (sex) creates stress on the heart has more to do with the emotional side than physical exertion,” Klein said.
Aside from the interaction with nitroglycerine, physicians said their biggest worry about Viagra comes from the increased sexual activity it makes possible, not the drug itself.
A spokesman from the Cook County medical examiner’s office said the Tinley Park man died from advanced stages of coronary atherosclerosis, or hardening of the arteries.
“He had severe coronary disease and it wouldn’t take much f,or him to die suddenly,” the spokesman said. “By looking at the severity of the coronary disease, you can tell he must have had it for years.”
The man had taken Viagra the day before his death, according to the spokesman.
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