The year was 1979, the place, a New York City townhouse, and 71-year-old former New York Governor Nelson Rockefeller, Vice President under Gerald Ford, died of a heart attack in the arms of a woman who was not his wife. The 26-year-old woman suddenly found herself in a mistress’ nightmare. Should she slip away, allowing Rockefeller to die and be discovered later with reputation intact? Or call 911 hoping to save him—and air dirty linen in public? She called 911.

Clearly, men—and women—can have heart attacks during sex. But how likely is this? Not very. Despite Rockefeller’s experience, the chance of heart attack during sex ranges from tiny to negligible. According to a recent Belgian report, you’re more likely to drop dead from drinking a cup of coffee than from a romp between the sheets.

The Belgian researchers reviewed 36 studies of people’s activities shortly before heart attacks. More than half (56 percent) weren’t doing anything special, but the rest (44 percent) were: experiencing road rage (7.4 percent), engaged in strenuous exercise, (6.2), drinking alcohol (5.0) or coffee (5.0), breathing heavily polluted air (4.8), suffering emotional distress (3.9), suffering non-traffic anger (3.0), eating a heavy meal (2.7), experiencing sudden joy, for example, being the guest of honor at a surprise party (2.4), having sex (2.2), or using cocaine (0.9), or marijuana (0.8). (These figures control for the relative frequency of the activities. Cocaine is a major heart attack trigger, but few people use it, hence its position near the bottom of the list.) So yes, sex can trigger heart attack, but you’re more likely to suffer chest pain from road rage, shoveling snow, or knocking back a few at a bar.

Corroborating these findings, Swedish researchers interviewed the survivors of 699 heart attacks, and found that only nine (1.3 percent) were sex-related. And those heart attacks clustered among the survivors who were least physically fit. The researchers concluded that risk of sex-related heart attack is “very low.”

Meanwhile, Tufts researchers reviewed 14 studies and concluded that for every hour spent having sex, risk of heart attack rises by “two to three per 10,000 person-years.” In other words, if everyone a sold out NBA game made love at their usual frequency for an entire year, two to three heart attacks would occur—a tiny risk. Furthermore, risk was greatest among those who made love only a few times a year. For those who were more regularly sexual, risk was only around one per 10,000 person-years, really tiny.

Is Sex Safe After Heart Attack?

In the 2003 movie, Something’s Gotta Give, a sixty-ish heart attack survivor (Jack Nicholson) hopes to bed a successful playwright (Diane Keaton), but wonders if his damaged heart can take the strain. His doctor (Keanu Reeves) says, “If you can climb a couple flights of stairs without chest pain, you can have sex.” Nicholson gazes longingly up a staircase and wonders when he’ll feel well enough to climb it—and get it on.

Hollywood movies are rarely good sources of medical information, but this time, the advice was correct. Sex is not strenuous. Even orgasm is rarely physically taxing. A few months after a heart attack, if you can ascend a flight or two of stairs comfortably, you can return to sex.

How to Enjoy Sex After a Heart Attack

• Follow your doctor’s advice. Your individual situation might make sex inadvisable, for example if you also have moderate-to-severe congestive heart failure. But after a few months, the vast majority of heart attack survivors can make love without fearing a recurrence.

• Adopt a heart-healthy lifestyle. It’s never too late to quit smoking, get daily moderate exercise, lose weight, manage stress, control blood pressure and cholesterol, eat less meat and cheese and more fruits and vegetables, and spend more time with those you love. In addition to helping the heart, a healthy lifestyle also increases libido and improves sexual function.

• Speaking of exercise, stress management, and time with loved ones, here’s a heart-saving tip: Make love regularly. Sex helps control stress. It’s gentle exercise that strengthens the heart. And assuming a loving relationship, it’s emotionally supportive. Maybe that’s why so many people call their lovers “sweetheart.”

• Finally, if you’re phobic about post-heart attack, a brief course of sex therapy should help you get back to getting it on. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

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