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To: MEDICAL EDITORS

Contact: John Murphy, +1-507-284-5005 (days), +1-507-284-2511 (evenings), e-mail: newsbureau@mayo.edu

ROCHESTER, Minn., Oct. 4 /Viagra price comparison
/ — Although medication
can help extend the lives of men with chronic heart failure, several factors
associated with this disease can interfere with a person’s ability to engage
in and enjoy sexual activities. Fatigue, depression, medication side effects
and the fear of damaging the heart can cause people with chronic heart failure
to lose interest in sex or wonder whether this activity is safe for them.

A literature review published in the October issue of Mayo Clinic
Proceedings finds that with proper screening and treatment, many patients with
chronic heart failure can safely engage in sexual activity.

Methods

Co-authors Stacy Mandras, M.D., Patricia Uber, Pharm. D., and Mandeep
Mehra, M.D., conducted systematic independent literature searches using the
MEDLINE database and examined a broad range of medical research that focused
on chronic heart failure, sexual activity and sexual dysfunction. This
literature included data from patient surveys and clinical trials.

Findings

Many people with chronic heart failure worry that having sex will place
too great a strain on the heart. To address this issue, Drs. Mandras and Mehra
analyzed studies that showed the impact of sexual activity on heart rate,
blood pressure and respiratory rates, which typically increase during sexual
activity and other forms of exertion.

One study the authors reviewed measured these changes in middle-aged men
with and without coronary artery disease. This study found that the peak heart
rate during intercourse was lower than heart rates measured during the
patients’ normal daily activities. The study participants’ peak oxygen
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levels during intercourse were moderate — comparable to their
oxygen consumption levels during moderate activities such as walking on level
ground at 3 to 4 miles per hour, climbing stairs slowly or doing general
housework such as vacuuming.

The authors also addressed how to counsel and treat chronic heart failure
patients who are coping with erectile dysfunction, difficulty achieving or
maintaining an erection. Researchers estimate that erectile dysfunction
affects 60 percent to 70 percent of people who have chronic heart failure.

The authors observe that multiple factors may be involved. In addition to
decreased exercise capacity, patients with chronic heart failure have blood
vessel and circulation abnormalities that can reduce blood flow into the penis
and interfere with the ability to maintain an erection. And erectile
dysfunction can be caused or worsened by many of the medications that are
commonly prescribed to treat chronic heart failure.

Currently, the preferred treatment for erectile dysfunction includes
sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). However,
numerous experts have raised concerns about the use of these drugs in patients
with chronic heart failure who also take nitrates (or other medications that
relax and widen blood vessels). This drug combination has been shown to be

dangerous, because it can increase the risk for a life-threatening drop in
blood pressure.

To further explore this potential risk, the authors reviewed results from
a variety of studies in which male patients with congestive heart failure took
sildenafil. The authors observed that more data are needed to determine the
safety of the newer drugs, vardenafil and tadalafil, for these patients.

“Taken together, these studies show that erectile dysfunction in patients
with mild to moderate chronic heart failure can be safely and effectively
treated with sildenafil, provided that patients are appropriately screened
before therapy,” say the authors.

For those patients who cannot take erectile dysfunction medications, the
authors counsel that an exercise training regimen may be an appropriate
substitute therapy to enhance sexual function and quality of life. The authors
stress that clinicians should focus on the sexual activity history of chronic
heart failure patients and not ignore it, since addressing this element can
substantially improve their quality of life.

Background about chronic heart failure

Chronic heart failure often develops after other cardiac problems have
damaged or weakened the heart, leaving it too weak or too stiff to fill and
pump efficiently. Many underlying heart conditions can lead to heart failure.
It can develop quickly after damage caused by a heart attack, or it can
develop gradually after years of high blood pressure or coronary artery
disease.

A peer-review journal, Mayo Clinic Proceedings publishes original
articles, reviews and editorials dealing with clinical and laboratory
medicine, clinical research, basic science research and clinical epidemiology.
Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical
Education and Research as part of its commitment to the medical education of
physicians. The journal has been published for more than 80 years and has a
circulation of 130,000 nationally and internationally. Articles are available
online at http://www.mayoclinicproceedings.com.

To obtain the latest news releases from Mayo Clinic, go to
http://www.mayoclinic.org/news. MayoClinic.com (http://www.mayoclinic.com) is
available as a resource for your health stories.

SOURCE Mayo Clinic

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