Abstract 969: Lifetime Risk for Sudden Cardiac Death at Selected Index Ages and by Risk Factor Strata and Race: Cardiovascular Lifetime Risk Pooling Project
Background: Sudden cardiac death (SCD) is a major public health problem, and it is often the first manifestation of cardiovascular disease. Lifetime risk (LR) for SCD has not been estimated.
Methods: We used NHLBI public-release datasets from the Framingham Heart Study (FHS), Cardiovascular Health Study (CHS) and Atherosclerosis Risk in Communities (ARIC) Study, which used diverse criteria to define SCD. In FHS, SCD was defined as a coronary death occurring within 1 hour of symptom onset and without other probable cause of death, after extensive review of records and next-of-kin interviews. LR for SCD to age 95 was estimated, with death free of SCD as the competing risk, for men and women at selected ages by risk factor strata and race.
Results: In the FHS, there were 2261 men and 2733 women followed for a total of 156,036 person-years; during follow up, 374 experienced SCD. At age 40, the overall LRs for SCD were 12.3% (95% CI 10.9 –13.7%) in men and 4.2% (3.4 – 4.9%) in women. Remaining LRs were lower at older index ages (e.g., 5.4% for men and 2.2% for women at age 80). LRs for SCD from age 50 in FHS are shown in the Table⇓, by risk factor strata. Greater individual and aggregate risk factor burden were associated with markedly higher LRs for SCD. Similar associations for risk factors and LR for SCD were observed in ARIC and CHS. In ARIC, LRs for SCD to age 75 were similar to FHS, with greater LRs in black than white men (4.5% vs 2.9%). In CHS, using a more restrictive definition for SCD (within 5 minutes of symptom onset), remaining LRs for SCD at age 65 to age 95 were higher for black than white men (8.7% vs 4.0%).
Conclusions: These results are the first estimates of lifetime risk for SCD. Established risk factors, male sex, and black race in men are associated with substantially increased lifetime risks for SCD. These relatively high lifetime risks (1 in 8 for men and 1 in 24 for women) should promote public health and individual efforts aimed at preventing this devastating consequence of cardiovascular disease.