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Original Research Article

Risk Factors of Sudden Cardiac Death in the Young

Multiple-Year Community-Wide Assessment

Reshmy Jayaraman, Kyndaron Reinier, Sandeep Nair, Aapo L. Aro, Audrey Uy-Evanado, Carmen Rusinaru, Eric C. Stecker, Karen Gunson, Jonathan Jui, Sumeet S. Chugh
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https://doi.org/10.1161/CIRCULATIONAHA.117.031262
Circulation. 2018;137:1561-1570
Originally published December 21, 2017
Reshmy Jayaraman
The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.J., K.R., S.N., A.L.A., A.U.-E., C.R., S.S.C.).
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Kyndaron Reinier
The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.J., K.R., S.N., A.L.A., A.U.-E., C.R., S.S.C.).
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Sandeep Nair
The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.J., K.R., S.N., A.L.A., A.U.-E., C.R., S.S.C.).
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Aapo L. Aro
The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.J., K.R., S.N., A.L.A., A.U.-E., C.R., S.S.C.).
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Audrey Uy-Evanado
The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.J., K.R., S.N., A.L.A., A.U.-E., C.R., S.S.C.).
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Carmen Rusinaru
The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.J., K.R., S.N., A.L.A., A.U.-E., C.R., S.S.C.).
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Eric C. Stecker
The Knight Cardiovascular Institute (E.C.S.)
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Karen Gunson
Department of Pathology (K.G.)
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Jonathan Jui
Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland.
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Sumeet S. Chugh
The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.J., K.R., S.N., A.L.A., A.U.-E., C.R., S.S.C.).
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Abstract

Background: Prevention of sudden cardiac arrest (SCA) in the young remains a largely unsolved public health problem, and sports activity is an established trigger. Although the presence of standard cardiovascular risk factors in the young can link to future morbidity and mortality in adulthood, the potential contribution of these risk factors to SCA in the young has not been evaluated.

Methods: We prospectively ascertained subjects who experienced SCA between the ages of 5 and 34 years in the Portland, Oregon, metropolitan area (2002–2015, catchment population ≈1 million). We assessed the circumstances, resuscitation outcomes, and clinical profile of subjects who had SCA by a detailed evaluation of emergency response records, lifetime clinical records, and autopsy examinations. We specifically evaluated the association of standard cardiovascular risk factors and SCA, and sports as a trigger for SCA in the young.

Results: Of 3775 SCAs in all age groups, 186 (5%) occurred in the young (mean age 25.9±6.8, 67% male). In SCA in the young, overall prevalence of warning signs before SCA was low (29%), and 26 (14%) were associated with sports as a trigger. The remainder (n=160) occurred in other settings categorized as nonsports. Sports-related SCAs accounted for 39% of SCAs in patients aged ≤18, 13% of SCAs in patients aged 19 to 25, and 7% of SCAs in patients aged 25 to 34. Sports-related SCA cases were more likely to present with shockable rhythms, and survival from cardiac arrest was 2.5-fold higher in sports-related versus nonsports SCA (28% versus 11%; P=0.05). Overall, the most common SCA-related conditions were sudden arrhythmic death syndrome (31%), coronary artery disease (22%), and hypertrophic cardiomyopathy (14%). There was an unexpectedly high overall prevalence of established cardiovascular risk factors (obesity, diabetes mellitus, hypertension, hyperlipidemia, smoking) with ≥1 risk factors in 58% of SCA cases.

Conclusions: Sports was a trigger of SCA in a minority of cases, and, in most patients, SCA occurred without warning symptoms. Standard cardiovascular risk factors were found in over half of patients, suggesting the potential role of public health approaches that screen for cardiovascular risk factors at earlier ages.

  • death, sudden, cardiac
  • epidemiology
  • heart arrest
  • population
  • prevention & control
  • risk factors
  • sports
  • Received November 22, 2016.
  • Accepted November 17, 2017.
  • © 2017 American Heart Association, Inc.
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April 10, 2018, Volume 137, Issue 15
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    Risk Factors of Sudden Cardiac Death in the Young
    Reshmy Jayaraman, Kyndaron Reinier, Sandeep Nair, Aapo L. Aro, Audrey Uy-Evanado, Carmen Rusinaru, Eric C. Stecker, Karen Gunson, Jonathan Jui and Sumeet S. Chugh
    Circulation. 2018;137:1561-1570, originally published December 21, 2017
    https://doi.org/10.1161/CIRCULATIONAHA.117.031262

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    Risk Factors of Sudden Cardiac Death in the Young
    Reshmy Jayaraman, Kyndaron Reinier, Sandeep Nair, Aapo L. Aro, Audrey Uy-Evanado, Carmen Rusinaru, Eric C. Stecker, Karen Gunson, Jonathan Jui and Sumeet S. Chugh
    Circulation. 2018;137:1561-1570, originally published December 21, 2017
    https://doi.org/10.1161/CIRCULATIONAHA.117.031262
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