Prospective Study of Sudden Cardiac Death Among Women in the United States

Harvard University, Cambridge, Massachusetts, United States
Circulation (Impact Factor: 14.43). 05/2003; 107(16):2096-101. DOI: 10.1161/01.CIR.0000065223.21530.11
Source: PubMed


There are few data regarding the determinants of sudden cardiac death (SCD) in women, primarily because of their markedly lower rate of SCD compared with men. Nonetheless, existing data, although sparse, suggest possible gender differences in risk factors for SCD.
In this prospective cohort of 121 701 women aged 30 to 55 years at baseline, SCD was defined as death within 1 hour of symptom onset. From 1976 to 1998, 244 SCDs were identified. Although the risk of SCD increased markedly with age, the percentage of cardiac deaths that were sudden decreased. Most (69%) women who suffered a SCD had no history of cardiac disease before their death. However, almost all of the women who died suddenly (94%) had reported at least 1 coronary heart disease risk factor. Smoking, hypertension, and diabetes conferred markedly elevated (2.5- to 4.0-fold) risk of SCD, similar to that conferred by a history of nonfatal myocardial infarction (relative risk, 4.1; 95% confidence interval, 2.9 to 6.7). Family history of myocardial infarction before age 60 years and obesity were associated with moderate (1.6-fold) elevations in risk. With regard to mechanism, 88% of SCDs were classified as arrhythmic. In 76% of these, the first rhythm documented was ventricular tachycardia or ventricular fibrillation.
These prospective data suggest that, as in men, coronary heart disease risk factors predict risk of SCD in women and that SCD is usually an arrhythmic death. Therefore, prevention of atherosclerosis or ventricular arrhythmias may reduce the incidence of SCD in women.

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    • "Although the prevention and medical management of cardiac disease is fast evolving, sudden cardiac death (SCD) remains the most common cause of death in the United States[1] [2] [3]. The mechanism of the onset of SCD is believed to be ventricular tachycardia that rapidly progresses to ventricular fibrillation and circulatory collapse. "
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    ABSTRACT: Life-threatening ventricular arrhythmias remain the main cause of death among patients with cardiovascular diseases. Efforts have been spent on early detection of such fatal cardiac signs. We have previously reported a novel chaotic phase space differential (CPSD) algorithm in discriminating VPC, VT, and VF from normal sinus rhythm with both good sensitivity and specificity. In this article, we apply this algorithm on the rat model of calcium induced ventricular tachycardia. Peaked CPSD values can be observed along with the occurrence of ventricular tachycardia. In addition, minor ECG changes such as new onset S wave or sinus arrhythmia can also be noted on CPSD tracing. We believe that the CPSD algorithm not only is capable of detecting lethal ventricular arrhythmias, but also is potentially a good tool for long-term monitoring the change of ECG signals.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 07/2013; 2013:2152-2155. DOI:10.1109/EMBC.2013.6609960
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    • "In previous epidemiological studies, patients with DM but no previously documented coronary artery disease appeared to be at higher risk of sudden cardiac death, with an HR ranging from 1.82– to 4.22 (11,24–26). In contrast, among studies that did not exclude patients with pre-existing coronary artery disease (27–30), the association between DM and sudden cardiac death remained equivocal. This could be partly related to the heterogeneity in the study populations: it has been postulated that the competing risks for sudden cardiac death related to coronary artery disease and other associated factors in these populations outweighed the increased risk related to DM (31). "
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    ABSTRACT: OBJECTIVE Diabetes mellitus (DM) is a well-established risk factor for coronary artery disease. Nonetheless, it remains unclear whether DM contributes to sudden cardiac death in patients who survive myocardial infarction (MI). The objective of this study was to compare the incidence of sudden cardiac death post-MI in diabetic and nondiabetic patients with no residual myocardial ischemia.RESEARCH DESIGN AND METHODSA total of 610 consecutive post-MI patients referred to a cardiac rehabilitation program with negative exercise stress test were studied.RESULTSOf these, 236 patients had DM at baseline. Over a mean follow-up of 5 years, 67 patients with DM (28.4%) and 76 of 374 patients without DM (20.2%) had died with a hazard ratio (HR) of 1.74 (95% CI: 1.28-2.56; P < 0.001). Patients with DM also had a higher incidence of cardiac death (1.84 [1.16-3.21]; P = 0.01), principally due to a higher incidence of sudden cardiac death (2.14 [1.22-4.23]; P < 0.001). Multiple Cox regression analysis revealed that only DM (adjusted HR: 1.9 [95% CI: 1.04-3.40]; P = 0.04), left ventricular ejection fraction (LVEF) ≤30% (3.6 [1.46-8.75]; P < 0.01), and New York Heart Association functional class >II (4.2 [1.87-9.45]; P < 0.01) were independent predictors for sudden cardiac death. Among patients with DM, the 5-year sudden cardiac death rate did not differ significantly among those with LVEF ≤30%, LVEF 31-50%, or LVEF >50% (8.8 vs. 7.8 vs. 6.8%, respectively; P = 0.83).CONCLUSION Post-MI patients with DM, even in the absence of residual myocardial ischemia clinically, were at higher risk of sudden cardiac death than their non-DM counterparts.
    Diabetes care 08/2012; 35(12). DOI:10.2337/dc12-0118 · 8.42 Impact Factor
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    • "In addition, medical intervention may be of little use in some cases – for example cardiac arrest resulting from non-shockable rhythms (e.g. asystole) [17]. However, the fundamental assumption underlying this research is that reducing deaths prior to transport will reduce the overall case fatality rate: transport and medical intervention should help at least some patients survive to hospital discharge [18]. "
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    ABSTRACT: In the United States, over one-third of premature cardiac deaths occur outside of a hospital, without any transport prior to death. Transport prior to death is a strong, valid indicator of help-seeking behavior. We used national vital statistics data to examine social and demographic predictors of risk of no transport prior to cardiac death. We hypothesized that persons of lower social class, immigrants, non-metropolitan residents, racial/ethnic minorities, men, and younger decedents would be more likely to die prior to transport. Our study population consisted of adult residents of the United States, aged 25 to 64 years, who died from heart disease during 1999-2000 (n = 242,406). We obtained transport status from the place of death variable on the death certificate. The independent effects of social and demographic predictor variables on the risk of a cardiac victim dying prior to transport vs. the risk of dying during or after transport to hospital were modeled using logistic regression. Results contradicted most of our a priori hypotheses. Persons of lower social class, immigrants, most non-metropolitan residents, and racial/ethnic minorities were all at lower risk of dying prior to transport. The greatest protective effect was found for racial/ethnic minority decedents compared with whites. The strongest adverse effect was found for marital status: the risk of dying with no transport was more than twice as high for those who were single (OR 2.35; 95% CI 2.29-2.40) or divorced (OR 2.29; 95% CI 2.24-2.34), compared with married decedents. Geographically, residents of the Western United States were at a 47% increased risk of dying prior to transport compared with residents of the metropolitan South. Our results suggest that marital status, a broad marker of household structure, social networks, and social support, is more important than social class or race/ethnicity as a predictor of access to emergency medical services for persons who suffer an acute cardiac event. Future research should focus on ascertaining "event histories" for all acute cardiac events that occur in a community, with the goal of identifying the residents most susceptible to cardiac fatalities prior to medical intervention and transport.
    BMC Cardiovascular Disorders 02/2006; 6(1):45. DOI:10.1186/1471-2261-6-45 · 1.88 Impact Factor
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