Sudden coronary death is a major manifestation of clinical
coronary artery disease which doubles in incidence with each decade of life after age 45, with women lagging behind men in incidence by 20 years. Some 14% of
heart attacks present as
sudden death, and 41% of deaths from
coronary disease are sudden deaths. Half of all sudden coronary deaths occur in persons without prior overt
coronary artery disease. Persons with established
coronary disease are at a three- to fourfold increased risk of
sudden death, but the proportion of coronary deaths due to
sudden death is no higher. This report examines how
sudden death evolves over the long term in the general population and in persons with overt
coronary artery disease, and attempts to delineate prime candidates and modifiable predisposing factors using the Framingham Heart Study. In asymptomatic persons the risk of
sudden death varies over a wide range in relation to risk factors such as systolic blood pressure, serum
cholesterol, cigarette smoking, heart rate, electrocardiographic abnormality and relative weight. Multivariate combination of these risk factors identifies 38.6% of sudden deaths in men and 43.8% of sudden deaths in women in the upper quintile of multivariate risk, which are, respectively, 6.0 and 5.8 times greater than the proportion of sudden deaths in the lowest quintile. When overt
coronary artery disease is manifest, the major risk factors have less influence on
sudden death risk, which becomes determined chiefly by indicators of intrinsic myocardial damage. With
cardiac failure there is an eightfold increased risk of
sudden death in men, and
cardiac failure without concomitant
coronary artery disease imposes a 2.7-fold increased risk.(ABSTRACT TRUNCATED AT 250 WORDS)