Murray Gary L, Colombo Joseph
Department of Cardiology, The Heart and Vascular Institute, Germantown, Tennessee.
Department of Cardiology, Physio PS, INC, Atlanta, Georgia.
Int J Angiol. 2021 Jul 19;30(4):271-276. doi: 10.1055/s-0041-1729629. eCollection 2021 Dec.
A total of 15 to 20% of deaths worldwide are sudden (within 1 hour of symptom onset). Our ability to predict and prevent sudden cardiac death (SCD) in the general population, in which 85% have no known organic heart disease (OHD) or stable OHD with left ventricular ejection fraction >40%, is limited to poor. The purpose of this commentary is to suggest a new approach to SCD in this population. Oxidative stress is a common thread in development and progression of the major cardiac diseases associated with SCD. It has a profound adverse effect upon heart rate variability (HRV), sympathetic tone (S), and parasympathetic tone (P). Recently, developed technology finally has allowed accurate measures of S and P. Using this technique, the general population can be screened, those at risk for SCD can be identified with a higher degree of success, and preventative measures instituted. For example, in 133 geriatric type 2 diabetics with S and/or P abnormalities upon screening, the potent and natural antioxidant (r)α lipoic acid reduced SCD (relative risk reduction) 43% ( = 0.0076), mean follow-up 6.31 years. Diabetes mellitus patients have high glycemic oxidative stress. Addressing oxidative stress S and P abnormalities can reduce SCD. S and P screening of the general population will be discussed.
全球范围内，15%至20%的死亡为猝死（症状发作后1小时内）。在普通人群中，我们预测和预防心脏性猝死（SCD）的能力有限，其中85%的人没有已知的器质性心脏病（OHD）或左心室射血分数>40%的稳定OHD。本评论的目的是提出一种针对该人群SCD的新方法。氧化应激是与SCD相关的主要心脏病发生和发展的共同因素。它对心率变异性（HRV）、交感神经张力（S）和副交感神经张力（P）有深远的不利影响。最近，发展起来的技术终于能够准确测量S和P。使用这项技术，可以对普通人群进行筛查，更成功地识别出SCD风险人群，并采取预防措施。例如，在133名筛查时S和/或P异常的老年2型糖尿病患者中，强效天然抗氧化剂（R）α硫辛酸使SCD（相对风险降低）降低了43%（P = 0.0076），平均随访6.31年。糖尿病患者存在高血糖氧化应激。解决氧化应激、S和P异常可降低SCD。本文将讨论普通人群的S和P筛查。
