Jerusalem, Returning to usual levels of sexual activity within a few months after a heart attack is positively associated with long-term survival, say researchers.

According to the study, published in the European Journal of Preventive Cardiology, sexuality and sexual activity are markers of wellbeing.

"Resumption of sexual activity soon after a heart attack may be a part of one's self-perception as a healthy, functioning, young and energetic person. This may lead to a healthier lifestyle generally," said study author Yariv Gerber of Tel Aviv University, Israel.

This study examined whether resumption of sexual activity shortly after hospitalisation for a first heart attack was associated with survival over more than two decades.

The researchers included 495 sexually active patients aged 65 years or under who were hospitalised for a first heart attack in 1992 to 1993. The average age was 53 years and 90 per cent were men.

Information about the frequency of sexual activity was collected by interview at two time points: during the initial hospitalisation and 3-6 months afterwards.

Based on the frequency reported at the two interviews, participants were classified into two groups: those who abstained from sexual activity or decreased its frequency following the heart attack (47 per cent) versus those who maintained or increased its frequency after the heart attack (53 per cent).

During a median follow-up of 22 years, 211 (43 per cent) patients died.

Maintaining or increasing the frequency of sexual activity within the first six months after a heart attack was associated with a 35 per cent lower risk of death compared with abstaining or reducing the frequency of sexual activity.

The survival benefit linked with maintaining or increasing the frequency of sexual activity was mostly attributed to a reduction in non-cardiovascular mortality such as cancer.

Professor Gerber said that becoming sexually active again shortly after a heart attack may be a marker for better clinical and psychosocial rehabilitation.

"Improved physical fitness, stronger spouse relations, and a mental ability to 'bounce back' from the initial shock of the event within a few months are among the possible explanations for the survival benefit observed among the maintained or increased group," he said.

"These findings should serve to reduce patients' concerns about returning to their usual level of sexual activity soon after a heart attack," Gerber concluded.