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. 2006 Mar 1;22(3):205-11.
doi: 10.1016/s0828-282x(06)70897-2.

Sudden unexpected cardiac death as a function of time since the detection of electrocardiographic and clinical risk factors in apparently healthy men: the Manitoba Follow-Up Study, 1948 to 2004

T Edward Cuddy  1 , Robert B Tate
Affiliations

Sudden unexpected cardiac death as a function of time since the detection of electrocardiographic and clinical risk factors in apparently healthy men: the Manitoba Follow-Up Study, 1948 to 2004

T Edward Cuddy et al. Can J Cardiol. .

Abstract
in English, French

Purpose: As the first and only manifestation of ischemic heart disease, sudden unexpected cardiac death (SUCD) is a serious clinical and epidemiological concern. Prospective population studies permit the identification of risk factors for SUCD. Knowledge of the short-and long-term risks for SUCD are key to understanding the basis of any intervention. The present paper explores the effect of time since the detection of factors on the risk for SUCD.

Subjects and methods: The Manitoba Follow-Up Study is a longitudinal, prospective study of 3983 originally healthy young men who have been followed with routine medical examinations since 1948. During 56 years of follow-up, SUCD occurred in 171 men. This analysis examined 21 possible risk factors for SUCD, including clinical findings, social variables and electrocardiographic abnormalities. Time-dependent covariate Cox proportional hazard models were used to estimate age-adjusted relative risks for SUCD. In multivariate models, the relative risk of SUCD was estimated as a function of time since the documentation of each risk factor.

Results: Excess alcohol consumption and T wave changes were associated with a high short-term risk for SUCD. Arterial hypertension and ST/T changes had sustained excess risk over both the short and long term. Newly developed left bundle branch block was a highly significant short-term risk that diminished with time.

Conclusion: These findings add new information for the clinical management of risk factors. The identification of time since the detection of these risk factors is an important consideration to reduce SUCD.

OBJECTIF: À titre de première et seule manifestation d’une cardiopathie ischémique, la mort cardiaque subite et inattendue (MCSI) est une préoccupation clinique et épidémiologique sérieuse. Des études de population prospectives permettent de repérer les facteurs de risque de la MCSI. Il est essentiel de connaître les risques à court et à long terme de la MCSI pour comprendre le fondement de toute intervention. Le présent article analyse l’effet du temps après la détection de facteurs affectant le risque de MCSI.

SUJETS ET MÉTHODOLOGIE: L’étude de suivi du Manitoba est une étude longitudinale prospective auprès de 3 983 jeunes hommes en santé au départ, suivis dans le cadre d’examens médicaux réguliers depuis 1948. Pendant ce suivi de 56 ans, une MCSI a tué 171 hommes. Cette analyse a permis de repérer 21 facteurs de risque possibles de MCSI, y compris les observations cliniques, les variables sociales et les anomalies électrocardiographiques. Les modèles des hasards proportionnels de Cox au moyen de covariables en fonction du temps ont été utilisés pour évaluer les risques relatifs de MCSI ajustés selon l’âge. Dans des modèles multivariés, le risque relatif de MCSI a été évalué comme fonction du temps depuis la documentation de chaque facteur de risque.

RÉSULTATS: Une consommation d’alcool excessive et des changements de l’onde T s’associent à un risque élevé de MCSI à court terme. L’hypertension artérielle et les changements ST/T s’accompagnaient d’un risque supplémentaire soutenu tant à court qu’à long terme. De nouveaux blocs de branche gauche représentaient un risque considérable à court terme, qui diminuait au fil du temps.

CONCLUSION: Ces observations s’ajoutent à l’information utile pour la prise en charge clinique des facteurs de risque. L’identification du temps après la détection de ces facteurs de risque constitue un facteur important pour réduire la MCSI.

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Figure 1)
Incidence of sudden unexpected cardiac death in the Manitoba Follow-Up Study (1948–2004)
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