Sex Won't Send a Heart Attack Survivor Back Into Cardiac Arrest

New research suggests that even for patients with a history of coronary heart disease, the risk of sexual activity triggering a heart attack is low. Christian Hartmann/Reuters

Though many patients with a history of coronary heart disease secretly may worry that a night of intimacy could result in another emergency room visit (or worse), it turns out the risk is incredibly rare, according to new data that seeks to shatter the myth that sex can trigger a heart attack.

A paper published this week in the Journal of the American College of Cardiology reviewed the health histories of 536 heart disease patients aged 30 to 70. The researchers examined when their last sexual activity occurred before their original heart attack. Just 0.7 percent of patients said they had sex within an hour before suffering a heart attack, while 78 percent said they had sex more than 24 hours before the heart attack.

The researchers also asked the patients about their sexual activity in the 12 months before their cardiac episode. Approximately 15 percent of patients reported no sexual activity in the year leading up to their heart attack. Over 95 percent reported having sex once per month or less, while 74 percent reported once per week or less. More than half (55 percent) said they had sex one or more times per week.

In follow-ups with patients 10 years later, there were zero reports of heart attack or stroke in the patients who took part in the study.

"When someone has intercourse and then has a heart attack after, it's really traumatic and so everyone hears about it," says Dr. Maryann McLaughlin, an associate professor of cardiology at Mount Sinai Hospital in New York City. She says more often than not, physicians don't address the issue and patients feel uncomfortable broaching the topic, which has also contributed to some of the misunderstandings about sex and heart attack risk.

There is some research that does look at the small population who suffer "sudden coital death." Interestingly enough, one study published in The Journal of Sexual Medicine found a man is more likely to have a heart attack while having sex with a mistress than during sex with his wife. Nelson Rockefeller, who was a U.S. vice president, is a famous case: He died at age 70 of a heart attack while he was cheating on his wife with a mistress who was in her mid-20s.

"I can just guess that with a new partner it might cause increase in blood pressure or exertion level," says McLaughlin about that research.

According to a paper published in Circulation, coital angina, also known as "angina d'amour," a type of chest pain caused by limited blood flow to the heart that occurs during or after sexual activity, represents less than 5 percent of all anginal attacks. Angina doesn't always lead to a heart attack, but it can be a sign of coronary heart disease.

McLaughlin says that when patients are wondering if it's safe to have sex, what they're really asking is how much physical exertion will be too taxing to the heart. Most people after a heart attack will be monitored by a cardiologist in routine follow-ups, including a stress test. In that test, a patient walks on a treadmill while being monitored. 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.

Additionally, patients can monitor their own fitness capacity and thus determine if sex is safe for their heart. McLaughlin says someone who can go up two flights of stairs or walk briskly at a "New York pace" without becoming winded will do just fine in the bedroom. The risk, she says, is in patients who are otherwise sedentary and then overexert themselves. These patients, especially ones with other underlying health conditions, such as diabetes, should talk with their doctor about how much physical activity is too much. McLaughlin tells her patients that sex is safe a few days after a stent has been put in and six weeks after open-heart surgery.

She added that for men, sexual function is also a great gauge for heart health. "Erectile dysfunction is the first symptom of coronary heart disease," she says. "These patients should be evaluated [for heart disease] instead of just asking for Viagra."