Men Face High Lifetime Risk of Sudden Cardiac Death

After age 45, the average man has a 1 in 9 chance of sudden cardiac death (SCD), and the average woman has a 1 in 30 chance, according to a new study.

“Most of these sudden cardiac deaths occurred before age 70, indicating a substantial burden of premature deaths that are largely preventable,” said study author Donald M. Lloyd-Jones, MD, ScM, in the Department of Preventive Medicine at the Feinberg School of Medicine in Chicago, Illinois. “The risks for having sudden cardiac death varied with the burden of heart disease risk factors, such as smoking, diabetes, elevated cholesterol, and elevated blood pressure, and blood pressure seemed to be a particularly important risk factor.”
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The researchers followed Framingham Heart Study participants who were free of cardiovascular disease before their earliest examination. They defined SCD as death attributed to coronary heart disease within 1 hour of symptom onset without another probable cause of death, as adjudicated by a panel of 3 physicians. The investigators estimated lifetime risk for SCD to 85 years old for men and women, with death attributed to other causes as the competing risk, and stratified by risk factor levels.

They followed 2294 men and 2785 women for 160,396 person-years, and 375 participants experienced SCD. At age 45, lifetime risks were 10.9% (95% confidence interval [CI], 9.4-12.5) for men and 2.8% (95% CI, 2.1-3.5) for women. A greater aggregate burden of established risk factors was associated with a higher lifetime risk for SCD. Categorizing men and women solely by blood pressure levels resulted in a clear stratification of lifetime risk curves.

“We screen for things like colon cancer routinely, and the lifetime risk for colon cancer in men is about 1 in 16, compared with 1 in 9 for sudden cardiac death,” Dr Lloyd-Jones said. “We need to address potential screening and get smarter about how to identify high-risk people in the general population. At present, this reinforces screening for traditional risk factors; it also suggests that a simple and widely available test like a resting 12-lead electrocardiogram might be helpful in detecting some of those people who are asymptomatic but may have the substrate for sudden death.”

Dr Lloyd-Jones is currently developing risk scores to detect people at high risk for SCD.

—Mike Bederka

Reference:

Bogle BM, Ning H, Mehrotra S, Goldberger JJ, Lloyd-Jones DM. Lifetime risk for sudden cardiac death in the community [published online June 29, 2016]. J Am Heart Assoc. doi:10.1161/JAHA.115.002398.