Frequency of Sexual Activity and Long-Term Mortality Risk in Patients After Acute Myocardial Infarction

Background: Several cohort studies of varying duration have demonstrated an inverse relationship between sexual activity and risk of death in the general population. To date, there are no studies examining sexual activity and mortality risk in survivors of acute myocardial infarction (AMI). We sought to assess the longitudinal relationship of sexual activity frequency with mortality in patients after AMI.

Methods: Patients aged 65 years or less (n=1120; mean age, 52.8 years; 86% men) discharged from 8 hospitals in central Israel after first AMI between 1992 and 1993 were followed through 2015. Self-reported frequency of sexual activity was attained during the index hospitalization (baseline), 5 years and 10-13 years post AMI, along with sociodemographic and clinical data. Cox regression models were constructed to estimate the hazard ratio for all-cause mortality associated with sexual activity handled as a time-dependent variable.

Results: At baseline, a low frequency (<1/week) of sexual activity was reported by 33% patients, a medium frequency (1/week) by 25%, and a high frequency (>1/week) by 42%. The respective frequencies were 55%, 22% and 23% at 5 years, and 58%, 21% and 21% at 10-13 years of follow-up. On average, less active patients were older, less likely to live with a steady partner, and had more severe AMI and more comorbidities. During a median follow up time of 18.3 years, 518 deaths (46%) occurred. A strong inverse relationship was observed between sexual activity frequency and death, which was attenuated but not eliminated with multivariable adjustment for multiple potential confounders (Table).

Conclusion: Our findings indicate an inverse association between sexual activity frequency and long-term mortality after AMI. Whether the relationship is causative or associative requires further elucidation.