Does “Bringing Sexy Back” Raise Risk of Heart Attack?

In commercials for erectile-dysfunction drugs such as Viagra or Cialis, as we see the happy middle-aged or older couple about to enjoy themselves thanks to the magic of modern medicine, the announcer’s voice-over warns: “Ask your doctor if your heart is healthy enough for sex.” But do people really pay attention to that disclaimer? Probably not.

A study that actually was done a few years ago, but which keeps popping up online in various places, including the Huffington Post, has given both men and women some cause for concern. The study1, which is actually a meta-analysis of four other studies, suggests that—especially for men in their 50s and 60s, which was the study population—episodic sexual activity was associated with a 2.7 RR (relative risk), or 2.7-fold higher risk, of triggering a heart attack. The study also examined episodic physical activity and found that to also have an increased association: (3.4 RR for MI, or myocardial infarction, and 4.98 RR for SCD, or sudden cardiac death).

What’s going on here? Isn’t physical exercise good for us? Isn’t sexual activity?

The key here is the word episodic (as in “short-term and occasional,” not as a form of television programming. Gotta make that distinction in this town!) The episodic nature of the exposures to physical exercise in men who were deconditioned and out of shape is what caused them to be dangerous and increase the men’s heart attack (MI) and SCD risks. Their bodies’ normal equilibrium was to be sedentary, so each episodic exercise event caused greater increases in heart rate, blood pressure, cortisol, and adrenaline—stress hormones that are not good for your heart and cause your heart to work harder. But with regular exercise, the heart becomes more used to exertion: heart rate drops over time and stress hormones are not triggered as much, because you are accustomed to the activity. That’s why our bodies benefit from regular, sensible physical exercise, even after a heart attack:
we call it cardiac rehab!

How does all of this relate to sex? Well, sex is a form of physical activity, which in some cases may be quite vigorous, Also, sex is an emotional activity (or, hopefully, it should be if you’re with the right person!) and where emotions are concerned, excitement may run high and so may adrenaline levels. We have all heard about the stories of older men who were reputed to have died of heart attacks while cheating on their wives with the secretary who is half their age. Here, the man is in fear he might be caught; he probably feels guilty. This raises adrenaline levels. He may have been drinking excessively or have just eaten a large meal. Bad combination in terms of predisposing him to a heart attack. These factors were not taken into consideration in the studies. But what about men who are not doing any of that? Should they still be worried? Well, by the reasoning and study data above, there appears to be some risk. But what does this 2.7 relative risk equate to in absolute terms? Good news: Almost nil. In fact, if you don’t have serious preexisting
coronary artery disease, probably about 0.9%, according to one study.2

This is because the episodes of sexual activity themselves generally do not last for extended periods of time. (No matter what you guys may tell your ladies!) Also, the most dangerous period of time in the sexual encounter for patients with preexisting coronary artery disease, the orgasm, during which heart rate and blood pressure rise significantly, may last only 10-15 seconds.

As the study explains it, the absolute baseline risk for a 50-year-old non-diabetic, non-smoking man suffering a heart attack is approximately 1%, which equates to 1 chance in a million per hour. Since engaging in sexual activity results in his approximately doubling his risk for an MI, he increases his risk to 2 in a million, and only for a 2-hour period. Although there is a slightly greater relative risk for patients with coronary artery disease, the absolute risk is still fairly low because of the short amount of time spent having sex.

Regular Exercise Offers a Protective Effect

The investigators found that engaging in regular, as opposed to episodic, exercise, conferred a protective effect on the heart, conditioning it for future exposures to both exercise and sexual activity. In fact, those study participants who were sedentary (exercised less than once a week) had a higher relative risk of MI associated with sexual activity (RR=3.0) than those who exercised three or more times per week (RR=1.2). That is a very significant difference!

Check With Your Doctor Anyway

We hate to say it, but, at the end of the day, the commercial is right. You should always check with your cardiologist to make sure that you don’t have a preexisting cardiac condition that may make your heart unusually susceptible to sexual activity. If you experience shortness of breath or other difficulty in breathing, chest pain, or irregular heartbeat after sex, these are symptoms of an underlying problem. See your cardiologist.


1 Dahabreh I, Paulus JK. Association of Episodic Physical and Sexual Activity With Triggering of Acute Cardiac Events. Systematic Review and Meta-analysis. JAMA. 2011;305(12):1225-1233.
2 Muller J, Mittleman M, Maclure M. Triggering Myocardial Infarction by Sexual Activity. Low Absolute Risk and Prevention by Regular Physical Exertion. JAMA. 1996;275(18):1405-1409.
Arash Bereliani, M.D., M.S., F.A.C.C. Beverly Hills Institute For Cardiology & Preventive Medicine

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