Skip to main content
Heart logoLink to Heart
. 2001 Oct;86(4):387–390. doi: 10.1136/heart.86.4.387

Sexual activity as a trigger of myocardial infarction. A case-crossover analysis in the Stockholm Heart Epidemiology Programme (SHEEP)

J Moller 1, A Ahlbom 1, J Hulting 1, F Diderichsen 1, U de Faire 1, C Reuterwall 1, J Hallqvist 1
PMCID: PMC1729949  PMID: 11559674

Abstract

OBJECTIVE—To investigate sexual activity as a trigger of myocardial infarction and the potential effect modification of physical fitness.
DESIGN—A case-crossover study nested in the Stockholm Heart Epidemiology Programme (SHEEP).
SETTING—Stockholm County from April 1993 to December 1994.
PATIENTS—All patients with a first episode of non-fatal acute myocardial infarction admitted to coronary care units were eligible, and 699 patients participated in an interview.
MAIN OUTCOME MEASURES—Relative risks with 95% confidence intervals.
RESULTS—Only 1.3% of the patients without premonitory symptoms had sexual activity during two hours before the onset of myocardial infarction. The relative risk of myocardial infarction was 2.1 (95% confidence interval (CI) 0.7 to 6.5) during one hour after sexual activity, and the risk among patients with a sedentary life was 4.4 (95% CI 1.5 to 12.9).
CONCLUSIONS—The increased risk of myocardial infarction after sexual activity and the further increase in risk among the less physically fit support the hypothesis of causal triggering by sexual activity. However, the absolute risk per hour is very low, and exposure is relatively infrequent. Thus having sex once a week only increases the annual risk of myocardial infarction slightly. Counselling should focus on encouraging patients to live a physically active life and not on abstaining from sexual activity.


Keywords: myocardial infarction; sexual activity

Full Text

The Full Text of this article is available as a PDF (114.5 KB).

Figure 1  .

Figure 1  

Illustration of the "usual frequency approach" in the case-crossover design.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bohlen J. G., Held J. P., Sanderson M. O., Patterson R. P. Heart rate, rate-pressure product, and oxygen uptake during four sexual activities. Arch Intern Med. 1984 Sep;144(9):1745–1748. [PubMed] [Google Scholar]
  2. Boykoff S. L. Strategies for sexual counseling of patients following a myocardial infarction. Dimens Crit Care Nurs. 1989 Nov-Dec;8(6):368–373. doi: 10.1097/00003465-198911000-00014. [DOI] [PubMed] [Google Scholar]
  3. Drory Y., Shapira I., Fisman E. Z., Pines A. Myocardial ischemia during sexual activity in patients with coronary artery disease. Am J Cardiol. 1995 Apr 15;75(12):835–837. doi: 10.1016/s0002-9149(99)80425-1. [DOI] [PubMed] [Google Scholar]
  4. Green A. W. Sexual activity and the postmyocardial infarction patient. Am Heart J. 1975 Feb;89(2):246–252. doi: 10.1016/0002-8703(75)90055-1. [DOI] [PubMed] [Google Scholar]
  5. Greenland S., Robins J. M. Estimation of a common effect parameter from sparse follow-up data. Biometrics. 1985 Mar;41(1):55–68. [PubMed] [Google Scholar]
  6. Hallqvist J., Möller J., Ahlbom A., Diderichsen F., Reuterwall C., de Faire U. Does heavy physical exertion trigger myocardial infarction? A case-crossover analysis nested in a population-based case-referent study. Am J Epidemiol. 2000 Mar 1;151(5):459–467. doi: 10.1093/oxfordjournals.aje.a010231. [DOI] [PubMed] [Google Scholar]
  7. Hellerstein H. K., Friedman E. H. Sexual activity and the postcoronary patient. Arch Intern Med. 1970 Jun;125(6):987–999. [PubMed] [Google Scholar]
  8. Larson J. L., McNaughton M. W., Kennedy J. W., Mansfield L. W. Heart rate and blood pressure responses to sexual activity and a stair-climbing test. Heart Lung. 1980 Nov-Dec;9(6):1025–1030. [PubMed] [Google Scholar]
  9. Louis T. A., Lavori P. W., Bailar J. C., 3rd, Polansky M. Crossover and self-controlled designs in clinical research. N Engl J Med. 1984 Jan 5;310(1):24–31. doi: 10.1056/NEJM198401053100106. [DOI] [PubMed] [Google Scholar]
  10. Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol. 1991 Jan 15;133(2):144–153. doi: 10.1093/oxfordjournals.aje.a115853. [DOI] [PubMed] [Google Scholar]
  11. Marshall R. J., Jackson R. T. Analysis of case-crossover designs. Stat Med. 1993 Dec 30;12(24):2333–2341. doi: 10.1002/sim.4780122409. [DOI] [PubMed] [Google Scholar]
  12. Masini V., Romei E., Fiorella A. T. Dynamic electrocardiogram in normal subjects during sexual activity. G Ital Cardiol. 1980;10(11):1442–1448. [PubMed] [Google Scholar]
  13. Mittleman M. A., Maclure M., Robins J. M. Control sampling strategies for case-crossover studies: an assessment of relative efficiency. Am J Epidemiol. 1995 Jul 1;142(1):91–98. doi: 10.1093/oxfordjournals.aje.a117550. [DOI] [PubMed] [Google Scholar]
  14. Muller J. E., Abela G. S., Nesto R. W., Tofler G. H. Triggers, acute risk factors and vulnerable plaques: the lexicon of a new frontier. J Am Coll Cardiol. 1994 Mar 1;23(3):809–813. doi: 10.1016/0735-1097(94)90772-2. [DOI] [PubMed] [Google Scholar]
  15. Muller J. E., Mittleman M. A., Maclure M., Sherwood J. B., Tofler G. H. Triggering myocardial infarction by sexual activity. Low absolute risk and prevention by regular physical exertion. Determinants of Myocardial Infarction Onset Study Investigators. JAMA. 1996 May 8;275(18):1405–1409. doi: 10.1001/jama.275.18.1405. [DOI] [PubMed] [Google Scholar]
  16. Muller J. E., Tofler G. H., Stone P. H. Circadian variation and triggers of onset of acute cardiovascular disease. Circulation. 1989 Apr;79(4):733–743. doi: 10.1161/01.cir.79.4.733. [DOI] [PubMed] [Google Scholar]
  17. Möller J., Hallqvist J., Diderichsen F., Theorell T., Reuterwall C., Ahlbom A. Do episodes of anger trigger myocardial infarction? A case-crossover analysis in the Stockholm Heart Epidemiology Program (SHEEP). Psychosom Med. 1999 Nov-Dec;61(6):842–849. doi: 10.1097/00006842-199911000-00019. [DOI] [PubMed] [Google Scholar]
  18. Reuterwall C., Hallqvist J., Ahlbom A., De Faire U., Diderichsen F., Hogstedt C., Pershagen G., Theorell T., Wiman B., Wolk A. Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the SHEEP study. The SHEEP Study Group. J Intern Med. 1999 Aug;246(2):161–174. doi: 10.1046/j.1365-2796.1999.00554.x. [DOI] [PubMed] [Google Scholar]
  19. Tardif G. S. Sexual activity after a myocardial infarction. Arch Phys Med Rehabil. 1989 Oct;70(10):763–766. [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

[Erratum in Table 1]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES