Bogle Brittany M, Ning Hongyan, Mehrotra Sanjay, Goldberger Jeffrey J, Lloyd-Jones Donald M
Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL.
McCormick School of Engineering, Northwestern University, Evanston, IL.
J Am Heart Assoc. 2016 Jun 29;5(7):e002398. doi: 10.1161/JAHA.115.002398.
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.
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.
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.
心源性猝死（SCD）是美国主要的死亡原因之一，且常常在没有先前心脏症状的情况下发生。此前尚未对SCD的终生风险以及已确定的风险因素对SCD终生风险的影响进行过评估。
我们对弗雷明汉心脏研究中在最早检查时无心血管疾病的参与者进行了随访。SCD被定义为在症状发作后1小时内归因于冠心病且无其他可能死因的死亡，由3名医生组成的小组判定。以死于其他原因作为竞争风险，对男性和女性直至85岁的SCD终生风险进行了估计，并按风险因素水平进行分层。我们对2294名男性和2785名女性进行了160396人年的随访；375人发生了SCD。45岁时，男性的终生风险为10.9%（95%CI，9.4 - 12.5），女性为2.8%（95%CI，2.1 - 3.5）。已确定的风险因素的总体负担越大，SCD的终生风险越高。仅根据血压水平对男性和女性进行分类，可使终生风险曲线明显分层。
我们首次给出了SCD的终生风险估计值。更大的总体风险因素负担或仅血压水平，都与SCD的更高终生风险相关。这种归因于心源性猝死的过早死亡高风险（约九分之一的男性和三十分之一的女性）应成为预防和应对SCD的公共卫生努力的动力。
