Adherence to a Low-Risk, Healthy Lifestyle and Risk of Sudden Cardiac Death Among Women

Study Questions:

Does a healthy lifestyle lower risk for sudden cardiac death (SCD) among women?


Data from the Nurses’ Health Study were used for the present analysis. Data on lifestyle factors assessed through questionnaires (every 2-4 years) from June 1984 to June 2010 were collected and a low-risk lifestyle was defined as not smoking, body mass index of less than 25, exercise duration of 30 minutes/day or longer, and top 40% of the alternate Mediterranean diet score. The Mediterranean diet score emphasized high intake of vegetables, fruits, nuts, legumes, whole grains, and fish and moderate intake of alcohol. The outcome of interest was SCD (defined as death occurring within 1 hour after symptom onset without evidence of circulatory collapse).


A total of 81,722 US women were included in this study. During the 26 years of follow-up, 321 cases of SCD were identified. Women were a mean age of 72 years at the time of the SCD event. All four low-risk lifestyle factors were significantly and independently associated with a lower risk of SCD. The absolute risks of SCD were 22 cases/100,000 person-years among women with 0 low-risk factors, 17 cases/100,000 person-years with one low-risk factor, 18 cases/100,000 person-years with two low-risk factors, 13 cases/100,000 person-years with three low-risk factors, and 16 cases/100,000 person-years with four low-risk factors. Compared with women with 0 low-risk factors, the multivariable relative risk of SCD was 0.54 (95% confidence interval [CI], 0.34-0.86) for women with one low-risk factor, 0.41 (95% CI, 0.25-0.65) for two low-risk factors, 0.33 (95% CI, 0.20-0.54) for three low-risk factors, and 0.08 (95% CI, 0.03-0.23) for four low-risk factors. The proportion of SCD attributable to smoking, inactivity, overweight, and poor diet was 81% (95% CI, 52%-93%). Among women without clinically diagnosed coronary heart disease, the percentage of population-attributable risk was 79% (95% CI, 40%-93%).


The investigators concluded that adherence to a low-risk lifestyle is associated with a low risk of SCD.


Prior work has demonstrated significant reductions in risk of heart disease and diabetes with lifestyle. This current study adds evidence for the benefits of lifestyle in prevention of SCD.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias

Keywords: Heart Diseases, Life Style, Follow-Up Studies, Body Mass Index, Overweight, Vegetables, Coronary Disease, Risk Factors, Death, Sudden, Cardiac

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