Lifetime Risk for Sudden Cardiac Death in the Community.
Lifetime Risk for Sudden Cardiac Death in the Community.
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DOI：
10.1161/jaha.115.002398
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发表时间：
2016-06-29
影响因子：
5.4
通讯作者：
Lloyd-Jones DM
中科院分区：
文献类型：
--
作者：
Bogle BM;Ning H;Mehrotra S;Goldberger JJ;Lloyd-Jones DM
心源性猝死（SCD）是美国的主要死因，通常发生在没有心脏症状的情况下。之前尚未估计SCD的终生风险和既定风险因素对SCD终生风险的影响。我们跟踪了在最早的检查之前没有心血管疾病的心脏病研究参与者。SCD定义为由3名医生组成的小组裁定的在症状发作1小时内归因于冠心病的死亡，没有其他可能的死亡原因。SCD的终生风险估计为男性和女性的85岁，其他原因导致的死亡作为竞争风险，并按风险因素水平分层。我们对2294名男性和2785名女性进行了160396人年的随访，其中375人经历了SCD。45岁时，男性和女性的终生风险分别为10.9%（95% CI，9.4-12.5）和2.8%（95% CI，2.1-3.5）。已确定的危险因素的总负担越大，SCD的终生风险越高。仅根据血压水平对男性和女性进行分类，导致终身风险曲线的明确分层。我们提出了SCD的第一个终身风险估计。更大的总体风险因素负担，或血压水平单独与SCD的更高终身风险相关。这种归因于SCD的过早死亡的高风险（约1/9的男性和1/30的女性）应作为公共卫生努力预防和应对SCD的动力。
Sudden cardiac death (SCD) is a leading cause of death in the United States and often occurs without previous cardiac symptoms. Lifetime risk for SCD and the influence of established risk factors on lifetime risks for SCD have not been estimated previously. We followed Framingham Heart Study participants who were free of cardiovascular disease before their earliest examination. SCD was defined as death attributed to coronary heart disease within 1 hour of symptom onset without another probable cause of death, as adjudicated by a panel of 3 physicians. Lifetime risk for SCD was estimated to 85 years of age for men and women, with death attributed to other causes as the competing risk, and stratified by risk factor levels. We followed 2294 men and 2785 women for 160 396 person‐years; 375 experienced SCD. At 45 years of age, lifetime risks were 10.9% (95% CI, 9.4–12.5) for men and 2.8% (95% CI, 2.1–3.5) for women. Greater aggregate burden of established risk factors was associated with a higher lifetime risk for SCD. Categorizing men and women solely by blood pressure levels resulted in a clear stratification of lifetime risk curves. We present the first lifetime risk estimates for SCD. Greater aggregate risk factor burden, or blood pressure level alone, is associated with higher lifetime risks for SCD. This high risk of premature death attributed to SCD (approximately 1 in 9 men and 1 in 30 women) should serve as a motivator of public health efforts in preventing and responding to SCD.