Murray GL, Colombo J. Sudden Cardiac Death in the General Population: Can We Improve Risk Stratification and Prevention?
Int J Angiol 2021;
30:271-276. [PMID:
34853574 DOI:
10.1055/s-0041-1729629]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
A total of 15 to 20% of deaths worldwide are sudden (within 1 hour of symptom onset). Our ability to predict and prevent sudden cardiac death (SCD) in the general population, in which 85% have no known organic heart disease (OHD) or stable OHD with left ventricular ejection fraction >40%, is limited to poor. The purpose of this commentary is to suggest a new approach to SCD in this population. Oxidative stress is a common thread in development and progression of the major cardiac diseases associated with SCD. It has a profound adverse effect upon heart rate variability (HRV), sympathetic tone (S), and parasympathetic tone (P). Recently, developed technology finally has allowed accurate measures of S and P. Using this technique, the general population can be screened, those at risk for SCD can be identified with a higher degree of success, and preventative measures instituted. For example, in 133 geriatric type 2 diabetics with S and/or P abnormalities upon screening, the potent and natural antioxidant (r)α lipoic acid reduced SCD (relative risk reduction) 43% ( p = 0.0076), mean follow-up 6.31 years. Diabetes mellitus patients have high glycemic oxidative stress. Addressing oxidative stress S and P abnormalities can reduce SCD. S and P screening of the general population will be discussed.
Collapse