Epidemiology of sudden death: insights from the Framingham Study.

Sudden death victims share most of the major risk factors for coronary disease in general; and the key to prevention is to reduce the risk of coronary attacks, especially by avoidance of cigarettes, correction of obesity, and reduction of blood pressure. The incidence increases with age, with sudden death incidence in women only a third that in men. By incorporating CHD risk factors into a multivariate logistic formulation, a composite estimate of risk is obtained over a wide range. A severely compromised coronary circulation manifested only by ECG abnormalities carries a high risk of sudden death. VPBs associated with sudden death often occur concurrently with ECG signs of LVH, intraventricular block, and nonspecific ST-T abnormalities. Convalescent MI patients with a low risk of sudden death are usually asymptomatic; have a normal creatinine, normal post-MI ECG, no tachycardia, a normal exercise ECG, few VPBs on monitoring, and normotension; and show no signs of cardiac failure.