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Sudden Cardiac Death and sex: Rare but not just an old man thing

A review of almost 7,000 comprehensive autopsies over 26 years in England showed that sex rarely triggered Sudden Cardiac Death (SCD) and more women than expected were affected, found a study in JAMA Cardiology.

The findings should reassure millions living with heart conditions that having sex doesn't pose a significant risk to their health. Charities have found that people diagnosed with cardiac conditions can experience anxiety about their sex life, with some worried that having intercourse could put excess strain on the heart.

“There has been a lack of understanding about the epidemiology of sudden death and sudden cardiac arrest during sexual activity,” said lead researcher Dr Gherardo Finocchiaro. “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.”

Mortalities occurred during or within one hour after sexual intercourse in just 0,2% of 6,847 SCD cases reviewed  and rates of post-sex death remained low across cases of SCD by cause of death: Sudden arrhythmic death syndrome: 0,2% aortic dissection; 2%
 arrhythmogenic cardiomyopathy; 0,7% hypertrophic cardiomyopathy; 0,3% ischaemic heart disease; 0,1% idiopathic fibrosis; 0,6%
 idiopathic left ventricular hypertrophy; 0,3% mitral valve prolapse: 1%.

In the St George’s University of London study, the 17 people who died from SCD after sex averaged just age 38, and two-thirds were men, reported Dr Mary Sheppard.

“Younger individuals (aged <50 years) with cardiac conditions, such as cardiomyopathies and channelopathies, may be concerned about their risk for sudden death during sexual intercourse because of the catecholaminergic surge that accompanies this activity,” they wrote.

“We believe these findings provide some reassurance that engaging in sexual activity is relatively safe in patients with a cardiac condition, especially in younger (aged <50 years) individuals.”

The investigators cited a 2006 study that associated sex with 0,2% of natural deaths that underwent autopsy, a cohort of predominantly middle-aged men (average age 59,1, 92,6% men).

“In the present cohort, we found that the proportion of female decedents was substantially higher than in previous studies. This difference was likely associated with the difference in age bracket, given that we included individuals with a mean age at death of 38 years and the other reports included older male individuals among whom a higher prevalence of coronary artery disease was expected,” Sheppard’s group noted.

The study relied on one cardiac pathology unit’s database of SCD cases referred from 1994 to 2020. SCD was defined as death occurring within 12 hours of apparent well-being. All cases underwent macroscopic and histological evaluation of the heart by cardiac pathologists.

Sheppard and colleagues cautioned that they did not include survivors of sudden cardiac arrests in their report, nor did they examine deaths after sex not attributed to SCD.

Study details

Association of Sexual Intercourse With Sudden Cardiac Death in Young Individuals in the United Kingdom

Gherardo Finocchiaro, Joseph Westaby, Elijah R. Behr, Michael Papadakis, ; Sanjay Sharma, Mary N. Sheppard,

Published in JAMA Cardiology on 12 January 2022

Sudden cardiac death (SCD) may occur in various circumstances, including physical exercise and sexual intercourse. A forensic study found that 0.2% of natural deaths that underwent autopsy were associated with sexual activity and predominantly involved middle-aged men.1 Using data from a large specialist cardiac pathology unit, we aimed to assess the proportion of SCDs associated with sexual activity and to describe the characteristics of this cohort and underlying causes of death.

Methods
We reviewed a database of SCD cases that were referred to the centre for cardiac pathology at St George’s University of London between January 1, 1994, and August 31, 2020. Ethical and research governance approval for this study was granted through the Integrated Research Application System (10/H0724/38). We followed the American Journal of Ophthalmology reporting guideline. Before referral, all SCD cases underwent a detailed autopsy, including a toxicological screening, to exclude noncardiac causes. Sudden cardiac death was defined as death occurring within 12 hours of apparent well-being. Clinical information was obtained from referring coroners, who were asked to complete a detailed questionnaire. All cases underwent macroscopic and histological evaluation of the heart by expert cardiac pathologists. A minimum of 10 blocks of tissue were taken for histological analysis, as reported in a previous study.2 Results are expressed as mean (SD) for continuous variables or as number of cases (%) for categorical variables. MedCalc, version 17.4 (MedCalc Software Ltd), was used for the statistical analysis.

Results
Of the total 6847 SCD cases we reviewed, death occurred during or within 1 hour after sexual intercourse in 17 (0.2%). The mean (SD) age at death was 38 (18) years, and most of the decedents (11 of 17 [65%]) were male individuals. One individual had a premorbid diagnosis of mitral valve prolapse, which was attributed as the cause of death, and 1 individual was diagnosed with hypertension and died of aortic dissection. In 2 individuals, extensive cardiac investigations did not lead to a definite diagnosis of cardiac disease.

A structurally normal heart at autopsy that was suggestive of sudden arrhythmic death syndrome was found in 9 individuals (53%), followed by aortic dissection in 2 individuals (12%). One death was attributed to each of the following causes: arrhythmogenic cardiomyopathy, hypertrophic cardiomyopathy, ischaemic heart disease, idiopathic fibrosis, idiopathic left ventricular hypertrophy (defined by raised heart weight and wall thickness in the absence of secondary causes and of myocardial disarray), and mitral valve prolapse. Sudden cardiac death that occurred during sex accounted for a low proportion of decedents even when causes of death were analysed (sudden arrhythmic death syndrome: 9 of 3426 [0.2%]; arrhythmogenic cardiomyopathy: 2 of 274 [0.7%]; hypertrophic cardiomyopathy: 1 of 265 [0.3%]; aortic dissection: 2 of 97 [2%]; ischaemic heart disease: 1 of 573 [0.1%]; idiopathic fibrosis: 1 of 165 [0.6%]; idiopathic left ventricular hypertrophy: 1 of 251 [0.3%]; mitral valve prolapse: 1 of 84 [1%]).

 

Medpage Today article – Death During Sex: Not Just an Old Man Thing (Open access)

 

JAMA Cardiology article – Association of Sexual Intercourse With Sudden Cardiac Death in Young Individuals in the United Kingdom (Open access)

 

See more from MedicalBrief archives:

 

Women under-treated for heart attack die at double the rate of men

 

COPD sufferers face increased risk of SCD

 

Common BP and angina drug may increase sudden cardiac arrest risk

 

 

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