Young People With Cardiac Conditions Rarely Die From Sex

For young individuals with inherited cardiac conditions such as cardiomyopathies or channelopathies, the risk of sudden cardiac death (SCD) during sexual intercourse is very low, according to a new report.

Among 6,847 SCD cases referred for cardiac pathology, just 17 people (0.2%) died during or within 1 hour after sex, a finding that should reassure patients with inherited cardiac conditions who are concerned about exerting themselves in the bedroom.   

“There has been a lack of understanding about the epidemiology of sudden death and sudden cardiac arrest during sexual activity,” lead researcher Gherardo Finocchiaro, MD, PhD (St. George’s, University of London, England), told TCTMD. “The rationale for the analysis, as it often does, stemmed from patients’ questions.”

Finocchiaro, who treats patients with inherited cardiac conditions, said the diagnosis can be hard on people as they process the lifestyle changes they need to consider. “Maybe not on the first visit, but maybe the second or the third, they often have questions about things that they can do and things they can’t do,” said Finocchiaro. “One of the questions is often about their sexual life and sexual activity. The reality is that it’s very difficult to answer this question, because we don’t have a lot of data about it.”

I had thought that the risk of dying suddenly during sexual activity in this population would have been higher than what we reported. Gherardo Finocchiaro

The new study, published as a research letter on January 12, 2022, in JAMA Cardiology, included SCD cases referred to their specialized center for cardiac pathology. Before referral, all SCD patients underwent a detailed autopsy and toxicological screening to exclude deaths from noncardiac causes.

Since SCD in most cases stemmed from inherited cardiac disorders, the study population overall was relatively young. Of those who had SCD triggered by sexual intercourse, the mean age was 38 years and 65% were male. Only one patient had previous cardiac symptoms, although four had a history of cardiac disease. 

Of the 17 individuals who died, the cause was sudden arrhythmogenic death syndrome in nine cases. Another two patients had an aortic dissection leading to SCD. The remaining causes of SCD were hypertrophic cardiomyopathy, ischemic heart disease, idiopathic left ventricular cardiomyopathy, idiopathic fibrosis, arrhythmogenic cardiomyopathy, and mitral valve prolapse (n = 1 for each).

Overall, the relatively small number of SCD cases linked to sexual activity is “reassuring,” Finocchiaro said, noting that the population includes patients with cardiomyopathies and channelopathies. “I had thought that the risk of dying suddenly during sexual activity in this population would have been higher than what we reported.”

To TCTMD, Finocchiaro said the risk of SCD can be worrisome for patients with ion-channel channelopathies and cardiomyopathies. In the past 5 or 10 years, there’s been a “paradigm shift” in thinking about the risk of SCD posed by exercise, he noted. Patients with cardiomyopathies and channelopathies were historically advised to engage in no physical activity at all, but that is no longer the case.

“Of course, in some conditions exercise is the trigger of sudden cardiac death, but the risk is not as much as previously thought,” he said “Within the spectrum of activities where there is a catecholaminergic surge, like sexual intercourse, this paper agrees with the paradigm shift about the risk of exercise in patients with cardiac conditions.”