(Reuters Health) - Heart attack survivors who have an active sex life are less likely than celibate counterparts to die in the decades following a first heart attack, a study in Israel suggests.

Researchers followed the fates of 1,120 men and women, who were 65 years old or younger at the time of their first heart attack, for up to 22 years. During the study period, 524 people died.

Compared to people who reported not having sex at all during the year before their heart attack, those who had intercourse more than once a week were 27% less likely to die during the study period, while those who had sex weekly were 12% less likely to die and people who had some sex - but not often - were 8% less likely to die.

The connection between sex and survival odds appeared even stronger for people with active sex lives after they had a heart attack, but with smaller differences between the people who were sexually active. Compared to survivors who never had sex, those who had sex less than once a week during the follow-up period were 28% less likely to die, while people who had sex weekly were 37% less likely to die and those who had sex more than once a week were 33% less likely to die.

“Not surprisingly, the people who were sexually active were more likely to be in a relationship, were younger, and generally healthier,” said Andrew Steptoe, head of the department of Behavioural Science and Health at University College London in the UK.

People who had sex more than weekly in the year before their heart attack were 49 years old on average at the start of the study, compared to an average age of 58 for people who had no sex at all the year before their heart attack.

Sexually inactive people were also more likely to have high blood pressure, high cholesterol, diabetes, and multiple chronic health problems in the year before the heart attack than people who had sex more than once a week.

Less than half of sexually inactive people lived with a steady partner in the year before their heart attack, compared with 94% of people who had sex more than once a week.

In the year prior to the heart attack, 67% of the people who didn’t have sex also didn’t exercise at all, compared with 45% of people who had sex more than weekly.

When researchers adjusted for age, lifestyle, other health conditions and socioeconomic factors, the link between being sexually active and survival weakened, Yariv Gerber of Tel Aviv University and colleagues write in the American Journal of Medicine. Gerber didn’t respond to requests for comment.

It’s possible frequent sex leads to biological changes that help people live longer, Gerber’s team writes. Sex is associated with longer caps on the end of chromosomes, known as telomeres, that tend to shrink with age and in response to stress, the study team writes. Longer telomeres are associated with longer life.

Regular sex is also linked to higher levels of the hormone testosterone in men and women, they add. Low testosterone is associated with both an increased risk of cardiovascular disease and low sexual desire - so people who have more sex may also have a lower risk of heart problems.

It’s also possible that being sexually active is a sign of better health rather than a cause of it. The study wasn’t designed to determine whether or how sex might help heart attack survivors live longer.

“Sexual activity is often part of a close and loving relationship as people age, but the relationship is probably more important than the sex,” Steptoe, who wasn’t involved in the study, said by email. “Although regular sex is part of healthy aging, people should not feel that they ‘ought’ to have sex in order to try to live longer.”

SOURCE: bit.ly/2YFImb4 American Journal of Medicine, online July 8, 2019.