What’s Your Real Risk of a Heart Attack after Cycling?

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By now, you know about the Sex and the City plotline where Chris Noth’s “Mr. Big” character had a heart attack after getting off his Peloton. And you probably know someone who was scared right off their indoor bike because of it.

What, really, are your chances of having a heart attack after a workout? Plug the bike back in. Here’s the deal on heart attacks after exercise:

Yes, exercise can raise the risk of a heart attack.

It does, but don’t hit the sofa yet. “Any sort of stressful event on your body can increase your heart rate, increase pressure in the arteries, and cause a plaque there to crack open and have a clot form on top of it. That’s what happens in a heart attack,” says Christopher Kelly, M.D. a cardiologist with UNC Health in North Carolina and co-author of Am I Dying?!: A Complete Guide to Your Symptoms and What to Do Next. But note: That’s any sort of physically or emotionally stressful event. “We even see an increase in heart attacks in the host country when the World Cup is on,” he says.

But it’s pretty rare to have a heart attack after exercise, especially if you’re healthy (keep in mind that most of the data so far is in men). Good research estimates the likelihood at 1 death per 792,000 person hours of exercise; another study puts it at 1 exercise-related cardiac arrest per 18,000 men.

You’re much more likely to have a heart attack if you don’t exercise.

That’s the exercise paradox: The more activity you do, the less likely a heart attack is. One review, according to a paper published in Circulation that puts the risks into perspective, found that people who did the most physical activity lowered their risk for cardiovascular mortality by 30 to 50 percent over people who did the least activity.

That risk is higher if you already have heart disease—the rate climbed to 1 event per 58,000 patient hours. But the authors of that perspective-giving paper point out that that’s still an extremely low risk.

If you’ve been sedentary, ease in.

“That’s making your heart work harder than it’s used to working,” Dr. Kelly says. “If you have undiagnosed heart disease and you’ve never had symptoms because you’ve never really pushed yourself and all of a sudden you’re trying to go from 0 to 60 in your first two weeks of exercise…that may not be the best idea.” Work up to intense exercise and let your body get used to it. “We sometimes recommend that adults over 50 with increased risk of heart disease who don’t exercise consult their doctor before they start an exercise program,” he says. They might do a stress test and evaluate your other risk factors. “But no doctor is going to tell you not to exercise. They just may have you ease into it,” he says.

Don’t attribute symptoms to being “out of shape.”

In the unlikely event you have symptoms of a heart attack during exercise or afterward (or any time, of course), don’t blow them off as just being out of shape. First of all, you don’t have to be out of shape to have a heart attack (although it does increase your risk). And second, these symptoms are telling you something. What to pay attention to: Pain or discomfort in the chest, in one or both arms as well as the back, neck, jaw or stomach; shortness of breath; also possibly breaking out in a cold sweat and experiencing nausea or lightheadedness. Find out more about what to look for here.

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