Sex as Part of a Heart-Healthy Lifestyle

Generally speaking, sex is a good thing. It helps people de-stress, feel closer to their partners, and more. But those with heart disease or a history of heart attack often worry that sex might trigger another cardiac event. A new study says that’s not the case and that, for most, even those who’ve had a heart attack in the past, sex is part of a heart-healthy lifestyle.

For the most part, sex won’t trigger a heart attack.

The study aimed to shatter the myth that sex can trigger a heart attack. To do this, researchers reviewed the health histories of over 500 heart disease patients aged 30-70. Most participants were 50+ and male at baseline. The researchers sought to answer three main questions:

How long before their heart attack did participants have sex?
How often did they have sex in the 12 months before their heart attack?
Did they have another heart attack in the 10 years since the original one?

What they found is that less than 1% of the participants had sex within an hour of their heart attack. For a very large majority, there were more than 24 hours between sex and the heart attack. Additionally, most participants were having sex on a regular basis in the year before their heart attack without problem. More than half did it at least once a week while 74% reported having sex somewhere between once a week and once a month. Lastly, when researchers followed up with patients after 10 years, 100 cardiac events were reported. This was less likely if patients were younger, male, generally active, and in good health.

This data is heartening; however it is also lacking some important information. For example, how often did participants have sex during those 10 years? A lot can change in a decade, including participants’ ability to have vigorous sex. Other common life changes that could impact their sex lives during this time include loss of a spouse to death or divorce, having children, menopause, opening or closing a relationship, getting injured, and being diagnosed with other conditions.

It also did not measure participants’ knowledge about the relationship between sex and heart attack or their intent to change their sex lives in any way as a result of the heart attack. Given the pervasiveness of this myth, these additional questions would make the results both more generalization and more weighty.

Rather than triggering a heart attack, sex may actually be heart-healthy.

The study’s researchers classified it as a safe moderate activity, similar to brisk walking. Cardiologists often recommend this type of activity to heart disease patients alongside a heart-healthy diet and medicines. While the researchers don’t go so far as to recommend sex as part of the patient’s physical activity plan, they note that doing it is better than not:

…our data still indicate that the benefits of [sexual activity] outbalance the relatively small risk, especially because very few patients at risk could be easily identified by physical examination and stress testing.

Healthcare providers aren’t talking to their patients about sex.

The study also found that most patients–less than half of men and less than a third of women–don’t get information about sex after a heart attack from their healthcare provider. This mirrors the narrative in the US where healthcare providers don’t talk to patients about sex, regardless of the diagnoses. Undoubtedly, the lack of conversation about sex contributed to the misunderstandings about sex and heart attacks.This makes it especially important for cardiologist to reassure patients when they can resume sex and/or make the appropriate referrals to providers who specialize in sexual issues if needed.

The question behind the question.

According to one cardiologist interviewed by Newsweek, when patients ask about sex, they really want to know how much they can exert themselves. She also discusses the routine follow-up that heart patients often have after a heart attack, including regular stress tests. She says,

This can help a physician determine if certain levels of physical exertion could be life-threatening, whether it’s jogging, snow shoveling, chasing after grandkids or having sex. Source

What this perspective doesn’t take into account is the socioeconomic factors that may prevent someone from getting these regular checkups. While the researchers controlled for age, sex, education, rehabilitation program, smoking status, diabetes, HDL level, self-reported physical activity, and other health factors, they do not go into detail about how these factors impacted the outcomes.

We need a more nuanced look at the connection between sex and heart health.

The study adds to the body of research that currently exists around the connection between sex and heart attack risk. It tells us that, in general, sex won’t lead to heart attack. This supports past research showing that coital angina, or angina d’amour, represents less than half of all anginal attacks. Though angina doesn’t always lead to a heart attack, it’s one indicator.

Other factors could increase the risk of having a heart attack during or immediately after sex. These include:

Being mostly sedentary outside of sexual activity.
Other underlying health conditions including diabetes.
Having sex with a new or forbidden (e.g. mistress) partner.

Any of these could increase blood pressure and/or exertion level, making sudden cardiac death more likely. So while this study gives generally good news, it should absolutely be interpreted based on the individual patient’s health and lifestyle.

The final piece of info that could add a lot to the conversation is whether the length, intensity, and type(s) of sex matter. For example, are there additional risks for those who have more vigorous sex? How about folks who take part in certain BDSM sex acts? Answering these questions will let healthcare providers give more accurate and personalized information about sex and heart attack risk.