The analysis showed that heart attacks, including fatal ones, were relatively rare when a man was having sex with his wife at home. But when he started to play away, the dangers grew.
German studies show that most men who died during sex were having an affair and meeting away from the family home. Furred-up arteries were blamed for more than a third of the deaths - the physical demands of sex is said to cause the fatty plaque that has built up inside arteries to rupture.
Heart attacks were the next biggest cause of death, the Journal of Sexual Medicine reports.
The stress of wining, dining and satisfying a woman who is likely to be younger than the man's wife may also be to blame, as can the strain of keeping an affair secret.
Researcher Dr Alessandra Fisher said extra-martial sex could be more stressful because the lover is often younger than the wife and the sex tends to follow more excessive drinking and/or eating.
"It is possible that a secret sexual encounter in an unfamiliar setting may significantly increase blood pressure and heart rate, leading to increased oxygen demand," Dr Fisher said.
Guilt may also play a role with some research suggesting heart problems are more common among cheats who are still attracted to their wife.
"Betraying this partner could punish him," she said.
The overview also suggests that in any one year, 4 per cent of married men will have an affair. Over the course of a man's life, there is a 50-50 chance of him straying.
- DAILY MAIL
