Exercise, Sex and Sudden Death

Can sex or exercise kill you?  Yes, a study published in JAMA concludes.  While this conclusion is nothing new, since after all, everyone of a certain age has heard the stories of intimate behavior followed by sudden cardiac death, and many of us have known folks, even very healthy ones, who died suddenly during exercise, this study is unique and interesting in other ways, as Rick and I agree in this week's podcast.

First among its interesting aspects for the nerds among us is the study design:  "case crossover."  What this means is that each person included in the study analysis acted as their own control.  For a study subject who experienced sudden cardiac death, or myocardial infarction or heart attack, all of their associated risk factors and behaviors are assumed to have been present before the event and therefore are not broken out as contributory factors.  So those who smoked or had high blood pressure or a family history of heart disease were considered to have had these factors present already.  Only the event of sudden cardiac death or heart attack counted.  For some of the cases of course it counted quite a lot; the study found that there was a several-fold increased relative risk of myocardial infarction or sudden cardiac death related to episodic  physical activity or sexual activity.

So that is the rub (thank you William).  The one factor that was teased out in the analysis was the relationship between regular physical activity, episodic physical or sexual activity, and death.  Turns out that those who engaged in regular physical activity had a reduced risk of dying or having a heart attack when they did get physical.  Clearly, and no surprise, regular exercise had a protective effect.

So what's the take home message?  As Rick quips in the podcast, we don't know about the effect of regular activity on one's risk related to sex, but do know it can help reduce the risk of deleterious consequences relative to exercise.  So if you're largely sedentary, begin a gradual exercise regime until you reach a target appropriate for you.  How to identify such a target?  Depending on your age and other health conditions, perhaps talking with your primary health care provider and having a few assessments is a good place to start.  If you already exercise regularly, congratulations!  Keep up the good work, and you shouldn't end up as one of those snow-shoveling statistics we all hear about from time to time.  And although it's outside the purview of this study, avoiding smoking and watching your weight will also help.

Other topics this week include the glitazone medications for diabetes in both BMJ and NEJM, use of car seats for children in Pediatrics, and fibrate use in the US and Canada in JAMA.  Until next week, y'all live well.

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