Sexual response in cardiovascular disease.

The cardiovascular response to sexual activity in men and women is similar to other daily activities and not excessive between couples in a long-standing relationship. The risk of an ischemic event during sexual activity is low and death very uncommon. Sexual dysfunction is common in cardiac patients and, in men, may occur before cardiac symptoms, with a time interval of 2 to 5 years. Exercise testing fails to identify nonobstructive but vulnerable-to-rupture lipid-rich plaques. Cardiac computed tomography identifies these silent plaques and triggers an aggressive risk-reducing management plan. As erectile dysfunction in men over 40 years of age is usually of vascular (endothelial dysfunction) origin, they should be considered "cardiovascular equivalents," and secondary prevention guidelines should be followed.