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Frequency of Sexual Activity and Long-term Survival after Acute Myocardial Infarction

      Highlights

      • We evaluated the association between sexual activity and mortality among Israeli patients aged ≤65 years after first acute myocardial infarction.
      • The frequency of sexual activity was reported at the index hospitalization and after 5 and 10-13 years.
      • Abstinence from sexual activity was increasingly reported during successive interviews, whereas a > once per week frequency was decreasingly reported.
      • Lack of partner and non-cardiac medical problem were the most commonly reported reasons for sexual abstinence 10-13 years after infarction.
      • Over a 22-year follow-up, an independent association was shown between sexual activity and survival.

      Abstract

      Background

      Previous studies have shown an inverse relationship between sexual activity and mortality in the general population. We evaluated the association between sexual activity and long-term survival among patients with acute myocardial infarction.

      Methods

      Patients aged ≤65 years (n=1120; mean age, 53) discharged from 8 hospitals in central Israel after first myocardial infarction from 1992-1993 were followed for mortality through 2015. Frequency of sexual activity was self-reported during the index hospitalization (baseline; referring to the year preceding the infarct) and after 5 and 10-13 years, along with sociodemographic and clinical data. Cox proportional hazards models were constructed to estimate the association with all-cause mortality in time-dependent sexual activity categories.

      Results

      At baseline, a > once per week frequency of sexual activity was reported by 42% of the patients, whereas no sexual activity was reported by 6%. After 10-13 years, the rates were 21% and 27%, respectively. Lower sexual activity was associated with older age, female sex, lack of a steady partner and more comorbidities. During follow-up, 524 deaths (47%) occurred. An inverse relationship was observed between sexual activity frequency and death, with hazard ratios (95% confidence intervals) of 0.30 (0.23-0.38) for > once per week, 0.36 (0.28-0.46) for once per week, and 0.53 (0.42-0.66) for < once per week, compared with none. After adjusting for relevant confounding factors, the estimates were attenuated to 0.68 (0.50-0.91), 0.63 (0.48-0.83), and 0.72 (0.57-0.93), respectively (P for trend = .004).

      Conclusions

      Using repeated assessments of sexual activity after myocardial infarction, an inverse association was demonstrated with mortality, which was only partly accounted for by measured potential confounders.

      Keywords

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