It has become a Hollywood cliché -- the older man who clutches his chest and keels over mid-way through having sex -- but is it as real as people think? New research from Tufts Medical Center suggests that sex does increase the risk of a heart attack, but the risk is still small and only rises during and soon after doing the deed.
Researchers analyzed past studies in which heart attack victims, mostly men in their 50s and 60s, were questioned about their activities just preceding and during their coronaries to see if sex served as a trigger for their cardiac events.
While they found that sexual activity caused a 2.7 increased risk of heart attack, the overall risk of heart attack was quite small and should not dissuade those with heart disease from indulging in a little bedroom action -- especially since several other studies show that regular sexual activity (usually defined as two or more times a week) actually decreases one's risk of heart attack over time.
Lead author Dr. Issa Dahabreh says people shouldn't take the new report to mean the sex is harmful for those with heart disease "because the absolute risk is really small."
What's more, patients could battle this increased risk by being physically active on a regular basis. Regular exercise made sex and other types of physical exertion less likely to be a trigger for heart attack, the study found.
"We saw a 45 percent reduction in the relative risk of heart attack with every additional weekly exercise session," says co-author Jessica Paulus, an epidemiologist at the Harvard School of Public Health.
"The main take-home [is that] regular exercise training, which we should be promoting anyway as a means to improve cardio respiratory fitness…will markedly reduce the risk associated with both acute exercise/exertion as well as sexual activity," says Dr. Chip Lavie, medical director of Cardiac Rehabilitation and Prevention at John Ochsner Heart and Vascular Institute.
The Coitus Conundrum
Many heart disease patients have fears of returning to normal types of physical activity following a heart attack or stroke. Given that sex carries the double whammy of physical exertion and emotional excitement, patients can be particularly apprehensive about returning to an active sex life.
And conflicting information on whether sex is heart-healthy or heart-hazardous doesn't make the situation any easier. The Tufts study, published Tuesday in the Journal of the American Medical Association, isn't the first identify sexual intercourse as a potential trigger for a cardiac event -- and anecdotally, there are many stories of people succumbing to a heart attack in coitus.
"Anything that increase heart rate and blood pressure puts strain on your heart and those who are not used to being physically fit are at higher risk of a cardiac event," says Dr. Philip Ragno, president of Island Cardiac Specialists in Garden City, N.Y.
"Emotional arousal [during sex] will also increase adrenaline and get heart rate going even in the absence of physical exertion," he adds.
While the risk could actually triple during and in the two hours following intercourse, as Tuesday's study finds, cardiologists urge that it's important to remember that the overall risk of such an event is rather small.
In a 2010 study published in the Lancet, for instance, researchers found that sex served as a trigger in only 2.2 percent of heart attacks. By comparison, indulging in a heavy meal was connected with triggering 2.7 percent of heart attacks.
What's more, the emotional and physical benefits of sexual satisfaction have been linked in several studies to overall health and specifically cardiac health.
In a 2010 study published in the American Journal of Cardiology, men between the ages of 50 and 70 were followed for 16 years and quizzed about sexual activity. Researchers found that sex twice a week reduced the risk of heart disease in these men by up to 45 percent, compared to their peers who had sex once a month or less.
Dr. Mehmet Oz, heart surgeon and host of the "Dr. Oz show," is also famous for recommending frequent sex (three times a week) as a way for men decrease their risk of heart attack and stroke by 50 percent.
So the exertion of a romp in the bedroom may briefly increase the risk of heart attack, but the cardiovascular and emotional benefits of regular sexual satisfaction far outweigh the downside, especially in those who are regularly active in other ways as well.
"The bottom line is that people should not fear sexual activity, but should fear sedentary lifestyle and physical inactivity," says Lavie.