Can Sex Cause a Heart Attack?

The Belgian researchers reviewed 36 studies that focused on people's activities shortly before heart attacks. More than half (56 percent) had been engaged in no particular activity. Here's what the rest (44 percent) were doing: getting angry in traffic (7.4 percent), exercising strenuously (6.2), drinking alcohol or coffee (5.0), breathing heavily polluted air (4.8), suffering emotional distress (3.9), seething with non-traffic anger (3.1), eating a heavy meal (2.7), experiencing sudden joy (2.4), having sex (2.2), using cocaine (0.9), using marijuana (0.8). (These figures control for the frequency of the activities: Cocaine is a major heart attack trigger, but few people use it, so it appears near the bottom of the list.)

So, yes, sex can trigger a heart attack. But the stats prove that you're more likely to suffer a cardiac event from road rage, shoveling snow or being the guest of honor at a surprise party.

Corroborating these findings, Swedish researchers interviewed the survivors of 699 heart attacks and found that only 1.3 percent had been triggered by sex. Not only that, the heart attacks clustered among the subjects who were least physically fit. The risk of sex-related heart attack is "very low," the researchers concluded.

Stateside researchers have contributed insights of their own: A Tufts University survey of 14 studies showed that sex-related heart attack risk is highest among those who are the least sexually active. For those who are more regularly sexual, the risk is barely "one per 10,000 person-years" — social science shoptalk for "minuscule."

When is it safe to resume sex after a heart attack? In Something's Gotta Give (2003), a 60ish heart attack survivor played by Jack Nicholson hopes to bed a successful playwright played by Diane Keaton. But something's sapping his mojo: Will his damaged heart, he wonders, be able to take the strain? His doctor (Keanu Reeves) advises him, "If you can climb a flight of stairs, you can have sex." Nicholson gazes longingly up a staircase outside Keaton's house, asking himself when he'll feel well enough to climb it again — and accomplish its sexual equivalent.

You might not think of Keanu Reeves as the world's most reliable source of medical advice, but in this case his counsel was correct. Sex is not strenuous. Even orgasm is rarely physically taxing. By and large, a few months after a heart attack, if you can comfortably ascend a flight or two of stairs, you can return to having sex. Here's how:

Follow your doctor's advice. Your individual situation might make sex inadvisable; this may apply if, for example, you also have moderate to severe congestive heart failure. After a few months, however, the vast majority of heart attack survivors can make love without fearing a recurrence.

Adopt a heart-healthy lifestyle. It's never too late to quit smoking, get daily moderate exercise, lose weight, manage stress, control your blood pressure and cholesterol, eat less meat and cheese (and more fruits and vegetables), or spend more time with those you love. In addition to helping the heart, these steps boost libido — and erections.

Make love regularly. You probably saw this coming when I mentioned the Tufts study above, but sex can help you manage stress. It's gentle exercise that strengthens the heart. And assuming you're in a loving relationship, it is emotionally supportive.

Could all this explain why so many people call their lovers "sweetheart"?

Longtime sexuality journalist Michael Castleman answers sex questions for free at GreatSexAfter40.com.