Sexual activity may improve survival after myocardial infarction

A longitudinal investigation of Israeli patients reveals that reported frequency of sexual activity after myocardial infarction (MI) is inversely associated with death.

“Using repeated assessments of sexual activity after MI, an inverse association was demonstrated with mortality, which was only partly accounted for by measured potential confounders,” the authors said.

The study followed 1,120 patients (mean age, 53 years) discharged from eight hospitals in central Israel after first MI from 1992–1993 for mortality through 2015. Participants self-reported the frequency of sexual activity during the index hospitalization (baseline; referring to the year preceding the infarct) and after 5 and 10–13 years, along with sociodemographic and clinical data.

The association with all-cause mortality in time-dependent sexual activity categories was estimated using Cox proportional hazards models.

At baseline, 42 percent of patients reported sexual activity of more than once per week, while 6 percent reported no sexual activity. The corresponding rates after 10–13 years were 21 percent and 27 percent. Those with lower sexual activity were more likely to be older, of female sex, have more comorbidities and lack a steady partner. [Am J Med 2020;133:100-107]

Nearly half (n=524; 47 percent) of the participants died during follow-up. Frequency of sexual activity inversely correlated with death (>1/week: hazard ratio [HR], 0.30, 95 percent confidence interval [CI], 0.23–0.38; 1/week: HR, 0.36, 95 percent CI, 0.28–0.46; <1/week: HR, 0.53, 95 percent CI, 0.42–0.66, compared with none).

These estimates decreased after adjusting for relevant confounding factors (>1/week: HR, 0.68, 95 percent CI, 0.50–0.91; 1/week: HR, 0.63, 95 percent CI, 0.48–0.83; <1/week: HR, 0.72, 95 percent CI, 0.57–0.93; p-trend=0.004).

Previous studies have suggested several biological mechanisms involved in the relationship between sexual activity frequency and survival. Baca and colleagues found a positive association between sexual intimacy and telomere length. [Psychoneuroendocrinology 2017;81:46-51]

“Telomeres are repeated nucleoprotein sequences (TTAGGG) that provide protection against replication and degradation in DNA material by stabilizing the ends of chromosomes,” the authors explained.

Another study suggested that low levels of testosterone correlated with the risk of cardiovascular disease events and appeared to reduce sexual desire. Moreover, menopausal women with lower levels of testosterone reported lower sexual desire, but they regained sexual interest upon administration of testosterone replacement therapy. [J Sex Res 2011;48:149-165; J Am Coll Cardiol 2016;67:545-557]

“Further elucidation of the mechanisms involved in the association [between sexual activity frequency and mortality] is warranted,” the authors said.

“From a practical standpoint, given that sexuality and sexual activity are markers of well-being, and prevalent causes for sexual abstinence, including medical (eg, erectile dysfunction and some cardiovascular disease medications) and psychological (eg, lack of interest, depression and fear) barriers, are … modifiable, sex and sexuality after MI should be targeted for intervention,” they added.