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July 20, 2011

Association Between Episodic Physical and Sexual Activity and Acute Cardiac Events—Reply

Author Affiliations

Author Affiliations: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts (Dr Dahabreh) (; and Tufts Clinical and Translational Science Institute, Tufts University, Medford, Massachusetts (Dr Paulus).

JAMA. 2011;306(3):265-266. doi:10.1001/jama.2011.984

In Reply: Dr Čulić suggests patients' sex may modify the association between episodic physical and sexual activity and acute cardiac events. Of the 7 studies investigating the triggering effect of episodic physical activity for myocardial infarction included in our systematic review, only 2 provided relative risk (RR) estimates stratified by sex. Random effects meta-regression provided an RR of 0.74 for women vs men (95% CI, 0.02-28.31; P for interaction = .75). Separate estimates for men and women were available from all 3 studies investigating the association of episodic physical activity and sudden cardiac death (RR, 0.46; 95% CI, 0.01-45.52; P for interaction = .55). In addition, only 2 of the 4 studies investigating the association of sexual activity and myocardial infarction provided estimates stratified by patients' sex (RR, 1.38; 95% CI, 0.02-126.19; P for interaction = .79). In short, we found little evidence of a difference between men and women. However, we caution that these results are based on a limited number of studies and there is considerable uncertainty around the RR estimates.

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