Limits...
Lifetime Risk for Sudden Cardiac Death in the Community

View Article: PubMed Central - PubMed

ABSTRACT

Background: Sudden cardiac death (SCD) is a leading cause of death in the United States and often occurs without previous cardiac symptoms. Lifetime risk for SCD and the influence of established risk factors on lifetime risks for SCD have not been estimated previously.

Methods and results: We followed Framingham Heart Study participants who were free of cardiovascular disease before their earliest examination. SCD was defined 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. Lifetime risk for SCD was estimated to 85 years of age for men and women, with death attributed to other causes as the competing risk, and stratified by risk factor levels. We followed 2294 men and 2785 women for 160 396 person‐years; 375 experienced SCD. At 45 years of age, lifetime risks were 10.9% (95% CI, 9.4–12.5) for men and 2.8% (95% CI, 2.1–3.5) for women. 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.

Conclusions: We present the first lifetime risk estimates for SCD. Greater aggregate risk factor burden, or blood pressure level alone, is associated with higher lifetime risks for SCD. This high risk of premature death attributed to SCD (approximately 1 in 9 men and 1 in 30 women) should serve as a motivator of public health efforts in preventing and responding to SCD.

No MeSH data available.


Related in: MedlinePlus

Lifetime risk for SCD at index age 45 years, stratified by blood pressure and sex. Lifetime risk of men with SBP <120 and DBP <80 at index age 45 significantly differs from those with SBP >160 or DBP ≥100 or on hypertension treatment. Lifetime risk for women with SBP <120 and DBP <80 does not significantly differ from those with SBP >160 or DBP ≥100 or on hypertension treatment. DBP indicates diastolic blood pressure; Rx, medical prescription; SBP, systolic blood pressure; SCD, sudden cardiac death.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5015355&req=5

jah31584-fig-0005: Lifetime risk for SCD at index age 45 years, stratified by blood pressure and sex. Lifetime risk of men with SBP <120 and DBP <80 at index age 45 significantly differs from those with SBP >160 or DBP ≥100 or on hypertension treatment. Lifetime risk for women with SBP <120 and DBP <80 does not significantly differ from those with SBP >160 or DBP ≥100 or on hypertension treatment. DBP indicates diastolic blood pressure; Rx, medical prescription; SBP, systolic blood pressure; SCD, sudden cardiac death.

Mentions: We also examined lifetime risk for SCD by individual risk factor levels at the selected index ages. Blood pressure levels stratified lifetime risk for SCD better than any other single risk factor. Adjusted cumulative risks for SCD by blood pressure strata for index ages 45, 55, 65, and 75 years are shown in Figures 5, 6, 7 through 8, respectively. Significant differences in lifetime risk are between those in the lowest blood pressure category and the highest blood pressure category at baseline and are noted in the figure captions. For men at all index ages and women of all but index age 45, those in the highest 2 blood pressure categories also had the highest lifetime risk for SCD. For example, men at index age 45 with lowest baseline blood pressure had significantly lower lifetime risk (P<0.001) compared to those in any of the higher baseline blood pressure categories. Men at index age 45 in the lowest blood pressure category (SBP <120 mm Hg and diastolic blood pressure [DBP] <80 mm Hg) have an adjusted cumulative lifetime risk (through 85 years) for SCD of 5.5%, those with SBP between 120 and 139 mm Hg or DBP 80 to 89 mm Hg have a 11.9% lifetime risk, and those with SBP between 140 and 159 mm Hg or DBP 90 to 99 mm Hg have a 12.8% lifetime risk, and those in the highest category (SBP ≥160 mm Hg, DBP ≥100 mm Hg, or on antihypertensive medication) have a 16.3% lifetime risk of SCD. Women had a significantly lower cumulative lifetime risk than men at all index ages, regardless of SBP/DBP, but blood pressure levels stratified their lifetime risk for SCD as well.


Lifetime Risk for Sudden Cardiac Death in the Community
Lifetime risk for SCD at index age 45 years, stratified by blood pressure and sex. Lifetime risk of men with SBP <120 and DBP <80 at index age 45 significantly differs from those with SBP >160 or DBP ≥100 or on hypertension treatment. Lifetime risk for women with SBP <120 and DBP <80 does not significantly differ from those with SBP >160 or DBP ≥100 or on hypertension treatment. DBP indicates diastolic blood pressure; Rx, medical prescription; SBP, systolic blood pressure; SCD, sudden cardiac death.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015355&req=5

jah31584-fig-0005: Lifetime risk for SCD at index age 45 years, stratified by blood pressure and sex. Lifetime risk of men with SBP <120 and DBP <80 at index age 45 significantly differs from those with SBP >160 or DBP ≥100 or on hypertension treatment. Lifetime risk for women with SBP <120 and DBP <80 does not significantly differ from those with SBP >160 or DBP ≥100 or on hypertension treatment. DBP indicates diastolic blood pressure; Rx, medical prescription; SBP, systolic blood pressure; SCD, sudden cardiac death.
Mentions: We also examined lifetime risk for SCD by individual risk factor levels at the selected index ages. Blood pressure levels stratified lifetime risk for SCD better than any other single risk factor. Adjusted cumulative risks for SCD by blood pressure strata for index ages 45, 55, 65, and 75 years are shown in Figures 5, 6, 7 through 8, respectively. Significant differences in lifetime risk are between those in the lowest blood pressure category and the highest blood pressure category at baseline and are noted in the figure captions. For men at all index ages and women of all but index age 45, those in the highest 2 blood pressure categories also had the highest lifetime risk for SCD. For example, men at index age 45 with lowest baseline blood pressure had significantly lower lifetime risk (P<0.001) compared to those in any of the higher baseline blood pressure categories. Men at index age 45 in the lowest blood pressure category (SBP <120 mm Hg and diastolic blood pressure [DBP] <80 mm Hg) have an adjusted cumulative lifetime risk (through 85 years) for SCD of 5.5%, those with SBP between 120 and 139 mm Hg or DBP 80 to 89 mm Hg have a 11.9% lifetime risk, and those with SBP between 140 and 159 mm Hg or DBP 90 to 99 mm Hg have a 12.8% lifetime risk, and those in the highest category (SBP ≥160 mm Hg, DBP ≥100 mm Hg, or on antihypertensive medication) have a 16.3% lifetime risk of SCD. Women had a significantly lower cumulative lifetime risk than men at all index ages, regardless of SBP/DBP, but blood pressure levels stratified their lifetime risk for SCD as well.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Sudden cardiac death (SCD) is a leading cause of death in the United States and often occurs without previous cardiac symptoms. Lifetime risk for SCD and the influence of established risk factors on lifetime risks for SCD have not been estimated previously.

Methods and results: We followed Framingham Heart Study participants who were free of cardiovascular disease before their earliest examination. SCD was defined as death attributed to coronary heart disease within 1&nbsp;hour of symptom onset without another probable cause of death, as adjudicated by a panel of 3 physicians. Lifetime risk for SCD was estimated to 85&nbsp;years of age for men and women, with death attributed to other causes as the competing risk, and stratified by risk factor levels. We followed 2294 men and 2785 women for 160&nbsp;396&nbsp;person&#8208;years; 375 experienced SCD. At 45&nbsp;years of age, lifetime risks were 10.9% (95% CI, 9.4&ndash;12.5) for men and 2.8% (95% CI, 2.1&ndash;3.5) for women. 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.

Conclusions: We present the first lifetime risk estimates for SCD. Greater aggregate risk factor burden, or blood pressure level alone, is associated with higher lifetime risks for SCD. This high risk of premature death attributed to SCD (approximately 1 in 9 men and 1 in 30 women) should serve as a motivator of public health efforts in preventing and responding to SCD.

No MeSH data available.


Related in: MedlinePlus