SUDDEN-DEATH - LESSONS FROM SUBSETS IN POPULATION STUDIES
SUDDEN-DEATH - LESSONS FROM SUBSETS IN POPULATION STUDIES
复制标题
DOI：
10.1016/s0735-1097(85)80545-3
复制
发表时间：
1985-01-01
影响因子：
24
通讯作者：
SCHATZKIN, A
中科院分区：
文献类型：
--
作者：
KANNEL, WB;SCHATZKIN, A
冠状动脉猝死是临床冠状动脉疾病的一个重要特征，45岁以后发病率每10岁增加一倍，女性发病率落后于男性20年。50%的男性和64%的女性猝死发生在既往无冠心病的人群中，18%的男性和24%的女性冠心病发作表现为猝死。超过一半的冠心病死亡是以猝死的形式发生的。患有明显的冠心病的人的风险增加3倍至12倍，这取决于年龄，风险比随着年龄的增长而降低。当明显的冠状动脉疾病被确定时，主要的冠状动脉危险因素对猝死的风险几乎没有明显的影响。风险似乎主要与心肌损害的程度有关，如心电图异常和心力衰竭的证据所示。在没有明显冠心病的受试者中，猝死的风险与危险因素有关，包括收缩压、血清胆固醇、肺活量、吸烟、相对体重、心率和心电图异常。这些危险因素的多变量组合可以有效地预测男性和女性的猝死。预防一般人群猝死的关键是通过避免或纠正上述危险因素来预防冠状动脉发作。迄今为止，尚未发现明确的猝死特异性风险因素。一旦出现明显的冠状动脉疾病，需要最大限度地减少心肌损伤和保护缺血心肌。
Sudden coronary death is an important feature of clinical coronary disease, the incidence doubling with each decade of age after age 45 and with women lagging behind men in incidence by 20 years. Fifty percent of the sudden deaths in men and 64% in women occur in persons without prior coronary heart disease, and 18% of coronary attacks in men and 24% in women present as sudden death. More than half of coronary mortality is in the form of sudden death. Persons with overt established coronary heart disease are at 3-fold to 12-fold increased risk depending on age, the risk ratio diminishing with advancing age. When overt coronary disease is established, the major coronary risk factors have little discernible effect on the risk of sudden death. Risk appears related chiefly to the degree of myocardial damage as indicated by electrocardiographic abnormality and evidence of cardiac failure.In subjects free of overt coronary heart disease, the risk of sudden death varies widely in relation to risk factors, including systolic pressure, serum cholesterol, vital capacity, cigarette smoking, relative weight, heart rate and electrocardiographic abnormality. Multivariate combination of these risk factors allows an efficient prediction of sudden death in both sexes. The key to the prevention of sudden death in the general population is to prevent coronary attacks by avoidance or correction of the aforementioned risk factors. No risk factors thus far identified are clearly specific for sudden death. Once overt coronary disease appears, minimization of myocardial damage and protection of the ischemic myocardium are required.