Patients with coronary heart disease (CHD), particularly men, are less likely to be sexually active than those without CHD, a large national study has shown.

Cross-sectional data on 2,979 men and 3,711 women aged 50 and older from the English Longitudinal Study of Ageing were analysed. There were 376 men and 279 women with CHD in the study, defined as a diagnosis of MI or angina pectoris.

Sexual activity, behaviour and concerns were assessed by a validated self-completion questionnaire the Sexual Relationships and Activities Questionnaire and analyses were weighted for non-response.

Covariates included age, partnership status and comorbidities.

Men with CHD were less likely to be sexually active (68.7% vs 80.0%) adjusted OR 0.62 (95% CI: 0.47-0.81), thought less about sex (74.7% vs 81.9%) OR 0.72 (95% CI: 0.54-0.95), and reported more erectile difficulties (47.4% vs 38.1%) OR 1.46 (95% CI: 1.10-1.93) than men without CHD.

Although overall women with CHD were also less likely to be sexually active than those without CHD, the difference was not significant.

These findings were more marked among those diagnosed recently.

Men diagnosed within four years were less likely to be sexually active than those without CHD (53.6% vs 80.0%), OR 0.24 (95% CI: 0.14-0.41).

The figures for women were 35.4% vs 55.6%, OR 0.44 (95% CI: 0.23-0.84) respectively.

It would therefore appear that there is a clear detrimental association between CHD and sexual activity, particularly among men.

There was only a weak association with cardiovascular medication and erectile dysfunction.

Sexual activity is an often neglected area in our management of patients with CHD. The effect of atherosclerotic changes on erectile function and the psychological impact of a coronary event on both sexes can have a profound effect on sexual activity. Quite often there is fear that another event could be provoked and this can adversely affect the desire to engage in sexual activity.

 ‘The heightened risk of erectile dysfunction and associated concerns in men with CHD requires focused advice and active management,’ the study authors say.

Dr Peter Savill

Steptoe A, Jackson SE, Wardle J. Sexual activity and concerns in people with coronary heart disease from a population-based study. Heart 2016;102:1095-99