Stein R A
Health Science Center at Brooklyn, State University of New York, Brooklyn, New York, USA.
Am J Cardiol. 2000 Jul 20;86(2A):27F-29F. doi: 10.1016/s0002-9149(00)00888-2.
The cardiovascular response to coitus and the risk of an acute cardiac event related to sexual activity is of clinical importance, especially now that effective pharmacologic treatment of male erectile dysfunction permits older men to resume active sex lives. Early studies by Masters and Johnson of young subjects engaging in coitus in laboratory settings reported that heart rates and systolic blood pressures were at near maximum exercise levels. Subsequent data from studies by Hellerstein and Friedman and by Stein in men with coronary artery disease, using ambulatory electrocardiographic recordings during coitus at home, demonstrated significantly lower heart rate and blood pressure responses to coitus. The associated myocardial oxygen demand of coitus in these men was found to in the range of moderate activities, often achieved or exceeded during their workday. The cardiovascular risk of coitus was addressed in the recent ONSET study in which myocardial infarction (MI) patients were interviewed shortly after their MI about potential triggering activities or events. Coitus was noted to represent a very low absolute risk of being a trigger for MI, but had an increased relative risk of 2.5 for the subjects in their study. Sexual intercourse will, in most men, represent only a moderate "stress" on the heart in terms of the responses that impact on myocardial oxygen requirement (heart rates, and systolic blood pressure). In patients with coronary artery atherosclerosis, coitus, compared with vigorous physical activity and intense emotional responses, represents a small risk of triggering an acute MI.
性交时的心血管反应以及与性活动相关的急性心脏事件风险具有临床重要性，尤其是现在男性勃起功能障碍的有效药物治疗使老年男性能够恢复积极的性生活。马斯特斯和约翰逊早期对在实验室环境中进行性交的年轻受试者的研究报告称，心率和收缩压接近最大运动水平。随后，赫勒斯坦、弗里德曼以及斯坦对患有冠状动脉疾病的男性进行研究，通过在家中进行性交期间的动态心电图记录，结果显示性交时的心率和血压反应明显较低。这些男性性交时相关的心肌需氧量处于中等活动范围，在他们工作日期间常常能够达到或超过这一水平。近期的“发作”（ONSET）研究探讨了性交的心血管风险，该研究对心肌梗死（MI）患者在心肌梗死后不久就潜在触发活动或事件进行了访谈。结果发现，性交作为MI触发因素的绝对风险非常低，但在他们的研究中，受试者的相对风险增加了2.5倍。就影响心肌需氧量的反应（心率和收缩压）而言，在大多数男性中，性交对心脏仅构成中等程度的“压力”。在患有冠状动脉粥样硬化的患者中，与剧烈体育活动和强烈情绪反应相比，性交引发急性MI的风险较小。
