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(Circulation. 1995;91:1749-1756.)
© 1995 American Heart Association, Inc.
Articles |
Risk Factors for Sudden Cardiac Death in Middle-Aged British Men
From the University Department of Public Health, Royal Free Hospital School of Medicine (G.W., A.G.S., M.W.), London, England, and the Department of Medical Cardiology, Royal Infirmary (P.W.M.), Glasgow, Scotland.
Correspondence to Dr Goya Wannamethee, University Dept of Public Health, Royal Free Hospital School of Medicine, Rowland Hill St, London NW3 2PF, England.
Background Risk factors specific to sudden cardiac death (SCD), ie, death within 1 hour after onset of symptoms, have been poorly identified, although recent findings from the present study incriminate heavy drinking and elevated heart rate. This paper examines the relations between a wide range of established and potential risk factors for ischemic heart disease (IHD) and SCD to identify independent risk factors for SCD and factors that might particularly or specifically relate to SCD.
Methods and Results We present a prospective study of a
cohort that was drawn from general practices in 24 British towns of
7735 middle-aged men who were followed up for 8 years. During 8 years
of follow-up, the men experienced 488 major IHD events (nonfatal and
fatal), of which 117 (24%) were classified as SCD. Age, preexisting
IHD, arrhythmia, systolic blood pressure, blood cholesterol, elevated
heart rate (
90 beats per minute), physical activity (all,
P<.05), and, to a lesser extent, smoking
(P=.06), HDL cholesterol (P<.07), and elevated
hematocrit (46%, P<.09) emerged as independent risk
factors for SCD after adjustment for a wide range of factors. Diabetes
was not found to be associated with SCD, and forced expiratory volume
in 1 second, body mass index, white blood cell count, and
antihypertensive drugs were not associated with risk of SCD after
adjustment. When examined in relation to non–sudden IHD deaths and
nonfatal myocardial infarction, elevated heart rate, heavy drinking,
and arrhythmia emerged as factors that appear to be specific or
particular to SCD. These three factors and age and blood cholesterol
were associated with an increased risk of SCD in men both with and
without preexisting IHD. Physical activity, systolic blood pressure,
and current smoking were associated with SCD only in men without
preexisting IHD. HDL cholesterol and hematocrit were strong predictors
of SCD only in men with preexisting IHD.
Conclusions Three risk factors appear to be specific or particular to the risk of SCD, and these and other risk factors operate differently in patients with versus those without preexisting IHD. These findings have implications for the causes and prevention of SCD.
Key Words: death, sudden • risk factors • ischemia • coronary disease
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