Prediction and Prevention of Sudden Cardiac Arrest
Commentary
Prediction and prevention of sudden cardiac arrest
Heikki V. Huikuri MD
See related research article by Reinier and colleagues on page 1705 and at www.cmaj.ca/lookup/doi/10.1503/cmaj.101512
Competing interests: None declared. This article was solicited and has not been peer reviewed. Correspondence to: Dr. Heikki V. Huikuri, heikki.huikuri@oulu.fi CMAJ 2011. DOI:10.1503 /cmaj.111245
CMAJ
ajor advances have been made in understanding the causes of and treatments for cardiovascular disease, and mortality related to such disease has been reduced. However, the incidence of sudden cardiac arrest has remained almost un changed for decades, generally affecting younger people (mean age about 65 yr) more so than other cardiovascular conditions causing death.1 Sudden cardiac arrest therefore represents a heavy burden to families, communities and the health care system. Several reasons have been identified for the lack of improvement in outcomes for people at risk of premature, unexpected, sudden cardiac arrest, such as insufficient understanding of the mechanisms responsible or of the role played by genetic or environmental factors and the lack of good parameters for stratifying risk. The study by Reinier and colleagues published in the CMAJ has tested the hypothesis that environmental factors, such as those found in North American neighbourhoods with lower socioeconomic status, are associated with a higher incidence of sudden cardiac arrest.2 The high incidence of cardiac arrest is recognized as the predominant mechanism of sudden cardiac death, especially among patients with coronary artery disease. As such, medical scientists and clinicians have sought ways of predicting and preventing these events. Previously identified variables that help predict the risk of sudden cardiac arrest among patients with structural heart disease
M
Key points
• The largest cumulative number of sudden cardiac arrests occurs among members of the general population
Prediction and prevention of sudden cardiac arrest
Heikki V. Huikuri MD
See related research article by Reinier and colleagues on page 1705 and at www.cmaj.ca/lookup/doi/10.1503/cmaj.101512
Competing interests: None declared. This article was solicited and has not been peer reviewed. Correspondence to: Dr. Heikki V. Huikuri, heikki.huikuri@oulu.fi CMAJ 2011. DOI:10.1503 /cmaj.111245
CMAJ
ajor advances have been made in understanding the causes of and treatments for cardiovascular disease, and mortality related to such disease has been reduced. However, the incidence of sudden cardiac arrest has remained almost un changed for decades, generally affecting younger people (mean age about 65 yr) more so than other cardiovascular conditions causing death.1 Sudden cardiac arrest therefore represents a heavy burden to families, communities and the health care system. Several reasons have been identified for the lack of improvement in outcomes for people at risk of premature, unexpected, sudden cardiac arrest, such as insufficient understanding of the mechanisms responsible or of the role played by genetic or environmental factors and the lack of good parameters for stratifying risk. The study by Reinier and colleagues published in the CMAJ has tested the hypothesis that environmental factors, such as those found in North American neighbourhoods with lower socioeconomic status, are associated with a higher incidence of sudden cardiac arrest.2 The high incidence of cardiac arrest is recognized as the predominant mechanism of sudden cardiac death, especially among patients with coronary artery disease. As such, medical scientists and clinicians have sought ways of predicting and preventing these events. Previously identified variables that help predict the risk of sudden cardiac arrest among patients with structural heart disease
M
Key points
• The largest cumulative number of sudden cardiac arrests occurs among members of the general population
References: 1. Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med 2001;345:1473-82. 2. Reinier K, Thomas E, Andrusiek DL, et al. Socioeconomic status and incidence of sudden cardiac arrest.CMAJ 2011;183:1705-12. 3. Huikuri HV, Mäkikallio TH, Raatikainen MJ, et al. Prediction of sudden cardiac death. Appraisal of the studies and methods assessing the risk of sudden arrhythmic death. Circulation 2003;108:110-5. 4. Zheng ZJ, Croft JB, Giles WH, et al. Sudden cardiac death in the United States. Circulation 2001;104:2158-63. 5. Kannel WB, Schatzkin A. Sudden death: lessons from subsets in population studies. J Am Coll Cardiol 1985;5(Suppl):141B-9B. 6. Tikkanen JT, Anttonen O, Junttila MJ, et al. Longterm outcome in patients with early repolarization patterns on electrocardiogram. N Engl J Med 2009; 361:2529-37. 7. Tu JV, Ko DT. Ecological studies and cardiovascular outcomes re search. Circulation 2008;118: 2588-93. 8. Stringhini S, Sabia S, Shipley M, et al. Association of socioeconomic position with health behaviors and mortality. JAMA 2010;303:1159-66. 9. Alter DA, Naylor CD, Austin P, et al. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 1999;341:1359-67. 10. Gorey KM, Holowaty EJ. Fehringer G, et al. An international comparison of cancer survival: relatively poor area of Toronto, Ontario and three US metropolitan areas. J Public Health Med 2000; 22:343-8. Affiliation: Heikki V. Huikuri is with the Department of Internal Medicine, Institute of Clinical Medicine, University of Oulu, Oulu, Finland. CMAJ, October 18, 2011, 183(15) 1693 Copyright of CMAJ: Canadian Medical Association Journal is the property of Canadian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder 's express written permission. However, users may print, download, or email articles for individual use.