Cheyenne Regional Medical Center, University of Colorado, Cheyenne, Wyoming, WY 82001, USA.
J Cardiovasc Pharmacol Ther. 2013 Sep;18(5):412-26. doi: 10.1177/1074248413491496. Epub 2013 Jun 13.
Sudden cardiac death (SCD) is still a major public health issue with an estimated annual incidence ranging from 184,000 to > 400,000 per year. The ACC/AHA/ESC 2006 guidelines define SCD as "death from an unexpected circulatory arrest, usually due to a cardiac arrhythmia occurring within an hour of the onset of symptoms". A recent study of sudden cardiac death using multiple sources of ascertainment found that coronary artery disease was present in more than 50% of patients older than 35 years who died suddenly and underwent autopsy. Antiarrhythmic drugs have failed to show any mortality benefit even when compared to placebo or implantable cardiovertor defibrillators (ICDs). While patients with systolic heart failure are at higher risk of dying suddenly, most of the patients experiencing sudden cardiac death have left ventricular ejection fraction (LVEF) > 50%. β-blockers, Angiotensin enzymes (ACE) inhibitors as well as aldosterone antagonists prevent ischemia and remodelling in the left ventricle especially in post myocardial infarction (MI) patients and in patients with systolic heart failure. This article will review the data on the effects of traditional heart failure medications, especially β-blockers, Renin Angiotensin system blockers, as well as Statin therapy on sudden cardiac death in post MI patients and in patients with systolic heart failure.
心脏性猝死（SCD）仍然是一个主要的公共卫生问题，估计每年的发病率在 184,000 至>400,000 例之间。ACC/AHA/ESC 2006 指南将 SCD 定义为“由于症状发作后 1 小时内发生的心律失常导致的意外循环骤停引起的死亡”。最近一项使用多种确定来源的心脏性猝死研究发现，在年龄超过 35 岁并接受尸检的突然死亡患者中，超过 50%的患者存在冠状动脉疾病。抗心律失常药物甚至与安慰剂或植入式心脏复律除颤器（ICD）相比，都未能显示出任何死亡率益处。虽然患有收缩性心力衰竭的患者突然死亡的风险较高，但大多数经历心脏性猝死的患者的左心室射血分数（LVEF）>50%。β受体阻滞剂、血管紧张素酶（ACE）抑制剂以及醛固酮拮抗剂可预防左心室缺血和重塑，特别是在心肌梗死后（MI）患者和收缩性心力衰竭患者中。本文将回顾传统心力衰竭药物（特别是β受体阻滞剂、肾素-血管紧张素系统阻滞剂以及他汀类药物）对 MI 后患者和收缩性心力衰竭患者心脏性猝死的影响数据。
