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. 2016 Jun 29;5(7):e002398.
doi: 10.1161/JAHA.115.002398.

Lifetime Risk for Sudden Cardiac Death in the Community

Brittany M Bogle  1 , Hongyan Ning  1 , Sanjay Mehrotra  2 , Jeffrey J Goldberger  3 , Donald M Lloyd-Jones  4
Affiliations

Lifetime Risk for Sudden Cardiac Death in the Community

Brittany M Bogle et al. J Am Heart Assoc. .

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.

Keywords: death; epidemiology; risk factors; sudden.

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Figures

Figure 1
Figure 1
Lifetime risk for SCD at index age 45 years, stratified by aggregate risk factor burden and sex. Risk factor burden strata are as follows: “All Optimal”: <120 systolic blood pressure (SBP) and <80 diastolic blood pressure (DBP) and <180 total cholesterol (TCL) and no previous diabetes mellitus diagnosis and not a current smoker; “≥1 Not Optimal”: SBP between 120 and 139 or DBP between 80 and 89 or TCL between 180 and 199 and no previous diabetes mellitus diagnosis and not a current smoker; “≥1 Elevated”: SBP between 140 and 159 or DBP between 90 and 99 or TCL between 200 and 239 and no previous diabetes mellitus diagnosis and not a current smoker; “1 Major (Exactly 1 of)” requires exactly one of the following: SBP ≥160 or DBP ≥100 or on treatment for hypertension,TCL ≥240, or on treatment for high cholesterol or a diabetes mellitus diagnosis or a current smoker; “≥2 Major (at least 2 of)” requires at least 2 of the following: SBP ≥160 or DBP ≥100 or on treatment for hypertension or TCL ≥240 or on treatment for high cholesterol or a diabetes mellitus diagnosis or a current smoker. Lifetime risk of men and women with ≥2 major risk factors at index age 45 statistically differs from those with all optimal risk factor burden. SCD indicates sudden cardiac death.
Figure 2
Figure 2
Lifetime risk for SCD at index age 55 years, stratified by aggregate risk factor burden and sex. Lifetime risk of men and women with ≥2 major risk factors at index age 55 statistically differs from those with all optimal risk factor burden. SCD indicates sudden cardiac death.
Figure 3
Figure 3
Lifetime risk for SCD at index age 65 years, stratified by aggregate risk factor burden and sex. Lifetime risk of men and women with ≥2 major risk factors at index age 65 does not statistically differ from those with all optimal risk factor burden. SCD indicates sudden cardiac death.
Figure 4
Figure 4
Lifetime risk for SCD at index age 75 years, stratified by aggregate risk factor burden and sex. Lifetime risk of men and women with ≥2 major risk factors at index age 75 does not statistically differ from those with all optimal risk factor burden. SCD indicates sudden cardiac death.
Figure 5
Figure 5
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.
Figure 6
Figure 6
Lifetime risk for SCD at index age 55 years, stratified by blood pressure and sex. Lifetime risk of men and women with SBP <120 and DBP <80 at index age 55 significantly differs 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.
Figure 7
Figure 7
Lifetime risk for SCD at index age 65 years, stratified by blood pressure and sex. Lifetime risk of men and women with SBP <120 and DBP <80 at index age 65 significantly differs 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.
Figure 8
Figure 8
Lifetime risk for SCD at index age 75 years, stratified by blood pressure and sex. Lifetime risk of men and women with SBP <120 or DBP <80 at baseline differs from those with SBP ≥160 or DBP ≥100 or on hypertension treatment at baseline. DBP indicates diastolic blood pressure; Rx, medical prescription; SBP, systolic blood pressure; SCD, sudden cardiac death.
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