Risk Factors of Sudden Death in the Young

Study Questions:

What is the potential contribution of standard cardiovascular risk factors (obesity, diabetes, hypertension, hyperlipidemia, smoking) for sudden cardiac arrest (SCA) in the young?

Methods:

The authors assessed resuscitation outcomes and clinical profile of subjects, aged 5-34 years, who suffered SCA between the ages of 5-34 years in Portland, OR. The association of standard cardiovascular risk factors for SCA, and sports as a trigger for SCA, was examined. Information from previous medical records, the SCA setting, or autopsy was available for the majority of subjects.

Results:

Out of 3,775 SCAs in all age groups, 186 (5%) occurred in the young (mean age 25.9 ± 6.8 years, 67% male). In young SCA, the overall prevalence of warning signs before SCA was low at 29%, and only 14% were associated with sports as a trigger. Sports-related SCA cases were more likely to present with shockable rhythms, and survival from cardiac arrest was 2.5-fold higher in sports-related versus nonsports SCA (28% vs. 11%; p = 0.05). The most common SCA-related conditions were sudden arrhythmic death syndrome (31%), coronary artery disease (22%), and hypertrophic cardiomyopathy (14%). There was a high prevalence of established cardiovascular risk factors, with ≥1 risk factor in 58% of SCAs.

Conclusions:

Standard cardiovascular risk factors were found in over half of the subjects. Sports was a trigger of SCA in a minority of cases, and in most patients, SCA occurred without warning symptoms.

Perspective:

It has previously been shown that the presence of standard cardiovascular risk factors in childhood may be associated with higher rates of morbidity and mortality in later years, but the present study raises the possibility that it may not take many years for these factors to increase the risk in the young person. The authors noted high prevalence of classical cardiovascular risk factors with ≥1 risk factor observed in nearly two thirds of SCA victims. The prevalence of obesity alone was 39%. High incidence of risk factors does not prove causality, but its potential impact on sudden death in the young should be studied further.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Sports and Exercise Cardiology, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Hypertension, Smoking, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology

Keywords: Arrhythmias, Cardiac, Cardiomyopathy, Hypertrophic, Cardiovascular Diseases, Coronary Artery Disease, Death, Sudden, Cardiac, Diabetes Mellitus, Heart Arrest, Hyperlipidemias, Hypertension, Medical Records, Obesity, Primary Prevention, Risk Factors, Smoking, Sports, Young Adult


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