Among those under 50, sex rarely leads to sudden cardiac death

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By Linda Carroll

NEW YORK (Reuters Health) - Sudden cardiac death in those under 50 is rarely associated with sexual activity, a new study finds.

An analysis of data from nearly 7,000 cases of sudden cardiac death revealed that just 17 were related to sexual intercourse, researchers report published in JAMA Cardiology.

"We believe these findings provide some reassurance that engaging in sexual activity is relatively safe in patients with a cardiac condition, especially younger (aged less than 50 years) individuals," Dr. Mary Sheppard of the University of London and colleagues write.

To take a closer look at whether sex causes sudden cardiac death, the researchers turned to a database of sudden cardiac death cases that were referred to the center for cardiac pathology at St. George's University of London between 1994 and 2020. Before the cases were referred, they underwent a detailed autopsy to exclude non-cardiac causes. The researchers defined sudden cardiac death (SCD) as deaths that occurred within 12 hours of apparent wellbeing.

The researchers reviewed a total of 6,847 SCD cases, in 17 of which death occurred during or within one hour after sexual intercourse. In each case, expert cardiac pathologists examined the heart macroscopically and histologically (a minimum of 10 blocks of tissue were analyzed). The mean age of the 17 at death was 38 and most (11) were male.

The researchers determined that in two cases an aortic dissection had occurred and one death (of six) was attributed to each of the following: hypertrophic cardiomyopathy, ischemic heart disease, idiopathic left ventricular hypertrophy (suggested by raised heart weight and wall thickness in the absence of secondary causes and of myocardial disarray), idiopathic fibrosis, arrhythmogenic cardiomyopathy or mitral-valve prolapse.

In the remaining nine, a structurally normal heart was found, "suggestive of sudden arrhythmic death syndrome," the researchers note.

The new study adds to mounting evidence that sexual activity rarely sparks sudden cardiac death, said Dr. Kerry Stewart, a professor of medicine and director of clinical and research exercise physiology at the Johns Hopkins School of Medicine, in Baltimore, Maryland.

"The metabolic demands of sexual activity indicate that the intensity is in the mild to moderate range for most people," Dr. Stewart told Reuters Health by email. "This is equivalent to a brisk walk or climbing a few flights of steps. There are certainly precautions for individuals with known cardiovascular disease, which most often becomes known with increasing age."

The underlying conditions leading to SCD in this study were mostly unknown to the individuals, Dr. Stewart said. "These conditions are not typically screened for unless there is a strong family history that could affect the individual because of congenital or genetic disorders," he added. "These are the same conditions that often explain the rare but sudden cardiac death of an apparently healthy athlete who collapses on the field."

"More work is needed to better understand, identify who is at greatest risk, and prevent sudden cardiac death from these cardiac abnormalities," Dr. Stewart said. "Today, routine screening of younger persons for participation in most physical activities including sports, working out for fitness, or sexual activity is not practical and beyond the resources of the medical community, given the very low prevalence of the causal conditions."

The paradox of physical activity is well known, "with regular activity being beneficial for health, but with a small incremental risk of SCA during acute strenuous exertion," said Dr. N.A. Mark Estes, III, program director for the Clinical Electrophysiology Fellowship at the University of Pittsburgh, Philadelphia.

"Prior studies have found that the typical patient with SCD associated with sexual intercourse was a middle-aged man with high cardiovascular risk, with a predominance of acute coronary syndrome and subarachnoid hemorrhage as main causes," Dr. Estes told Reuters Health by email. "Prior studies have also noted an extremely low rate of bystander CPR in this setting where a witness is universal."

"This may result from fear and lack of training and likely contributes to the observed almost five-fold lower survival rate in comparison with other physical activity-related SCA," Dr. Estes said. "These observations provide an opportunity to improve outcomes through better public awareness and education for this particular manifestation of SCA that could be very emotionally traumatic for the partner."

Dr. Sheppard did not respond to requests for comment.

SOURCE: https://bit.ly/33pKc42 JAMA Cardiology, online January 12, 2022.

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