A study using over a decade of national health survey data found that adults with cardiovascular disease who also reported low sexual frequency faced significantly higher mortality risk than those with cardiovascular disease who remained sexually active.
Researchers have long recognized cardiovascular disease as the world’s leading cause of death, but comparatively little work has examined how sexual activity intersects with long-term survival in people who already have the condition. Two recent analyses of the same large US survey database now suggest that sexual frequency may function as a meaningful, and often overlooked, clinical variable in cardiovascular care.
Prior research including the Caerphilly Cohort Study in Wales and work from Duke University had pointed toward associations between regular sexual activity and reduced cardiovascular risk. Mechanisms proposed in earlier literature include reductions in heart rate variability, lower blood pressure, and stress reduction. Those studies, however, largely examined sexual activity as a predictor of developing heart disease, not as a modifier of outcomes once disease is already present.
How the studies were conducted
Both analyses drew on six consecutive two-year cycles (2005–2016) of the National Health and Nutrition Examination Survey (NHANES), a nationally representative program that assesses the health of non-institutionalized US adults. Participants were asked about cardiovascular diagnoses and about sexual activity through in-person interviews.
In the Davis, Anderson, and Banerjee study, published in Healthcare in February 2025, the sample consisted of adults aged 20 to 59. Low sexual frequency was defined as having vaginal or anal sex fewer than 11 times per year — less than once a month — a threshold drawn from prior validated research. Cardiovascular disease was identified through self-reported diagnoses of conditions including congestive heart failure, coronary heart disease, angina, heart attack, and stroke. All-cause mortality was tracked using linked National Death Index records through December 2019. The researchers used Kaplan-Meier survival curves and Cox regression models, adjusting for age, ethnicity, education, obesity, diabetes, hypertension, and smoking.
A separate analysis by Teng and colleagues, published in Scientific Reports in December 2024, examined 17,243 NHANES participants and used multivariable logistic and Cox regression models alongside restricted cubic spline analysis to assess both the incidence of cardiovascular disease and all-cause mortality across different levels of sexual frequency.
What the results showed
In the Davis et al. study, the unadjusted hazard ratio for all-cause mortality among people with CVD compared to those without it was 5.1. After adjusting for demographic and health variables, the hazard ratio remained elevated at 2.3 among individuals who had CVD and low sexual frequency, but fell close to 1.0 among individuals who had a history of CVD but reported moderate-to-high or high sexual frequency.
The Teng et al. study, examining a younger and middle-aged US adult population, similarly found an association between lower sexual frequency and both higher CVD incidence and higher all cause mortality.
What the researchers concluded
The Davis et al. team stated their study was the first to demonstrate, in both unadjusted and adjusted models, that CVD combined with low sexual frequency produces worse outcomes than CVD alone, and they argued this finding indicates the need to take a sexual history from individuals with CVD or other chronic diseases.
The Teng et al. researchers similarly concluded that sexual frequency carries significance as a health-related variable in cardiovascular populations, though they framed their findings as contributions to an ongoing body of work rather than a definitive endpoint.
Several important constraints apply to both studies. Both rely on NHANES data, meaning sexual frequency and cardiovascular diagnoses were obtained through self-report, which introduces recall and social desirability bias. The studies are observational in design, meaning they can establish association but not causation — it is not possible from this data alone to determine whether low sexual frequency contributes to worse cardiovascular outcomes, whether worsening cardiovascular health reduces sexual activity, or whether a third variable explains both.
The measure of sexual frequency was limited to vaginal or anal sex, and did not capture other forms of sexual expression, meaning the findings may not fully represent the spectrum of sexual activity. The Davis et al. sample covered adults aged 20 to 59 only, so findings may not generalize to older adults, who represent the majority of cardiovascular disease burden. Additionally, the NHANES data used predates 2017, and trends in sexual behavior and cardiovascular treatment have continued to evolve.
REFERENCES:
Davis, W.S., Anderson, P., and Banerjee, S. “Cardiovascular Disease and All-Cause Mortality Among Individuals with Low Sexual Frequency.” Healthcare, vol. 13, no. 5, 461. MDPI, 2025.
Teng, T.Q., Liu, J., Wang, M.M., Mo, D.G., Chen, R., Xu, J.C., Dong, Z.H., Zhang, N., and Yu, H.C. “The Association of Sexual Frequency with Cardiovascular Diseases Incidence and All-Cause Mortality.” Scientific Reports, vol. 14, 31925. Nature Portfolio, 2024.
