April 1, 1975Circulation485 citationsOpen Access
Precursors of sudden coronary death. Factors related to the incidence of sudden death.
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Key Result
Over 16 years, high blood pressure, left ventricular enlargement, obesity, and heavy smoking were positively correlated with sudden coronary death, which accounted for 109 of 234 CHD deaths.
Key Points
- Identify precursive clinical factors and risk markers associated with sudden versus nonsudden fatal coronary heart disease.
- Prospective surveillance of 1,838 civil servants in Albany, New York, and 2,282 Framingham, Massachusetts residents followed continuously for 16 years.
- Tracked 4,120 men aged 45 to 74 years for coronary heart disease mortality and clinical characteristics preceding fatal events.
- Out of 234 coronary heart disease deaths, 109 occurred within one hour of symptom onset; over 50% of CHD deaths occurred out of hospital, and approximately 80% of these were sudden and unheralded by prior symptoms.
- Sudden death risk correlated positively with high blood pressure, electrocardiographic left ventricular enlargement, obesity, and heavy cigarette smoking.
- Precursive risk profiles did not distinguish individuals who died suddenly from those who died slowly from myocardial infarction.
Study Design
Type
Cohort (n=4,120)
Multicenter
Yes
Structured PICO
P
Population
4,120 men (1,838 civil servants in Albany, New York, and 2,282 residents of Framingham, Massachusetts) aged 45-74 years old
O
Outcome
Sudden death (death attributed to coronary heart disease occurring within one hour of onset of symptoms)hard clinical
Sudden coronary death shares the same precursive risk factors as general coronary attacks (hypertension, left ventricular enlargement, obesity, smoking), suggesting that preventing sudden death requires the prevention of coronary disease overall.
Abstract
Precursors of sudden death were sought in men--1838 civil servants in Albany, New York, and 2282 residents of Framingham, Massachusetts--under continuous surveillance for 16 years. In men 45-74 years old there were 234 deaths attributed to coronary heart disease (CHD) of which 109 occurred within one hour of onset of symptoms. More than half of all deaths due to CHD occurred outside the hospital and about 80 per cent of these were sudden. Most were unheralded by prior symptoms of CHD. Persons at high risk of death from CHD, including sudden death, can be identified long before the terminal unexpected catastrophe. The same precursive stigmata exist in persons subject ot coronary attacks whether or not immediately fatal. The risk of sudden death in these two populations was positively correlated with high blood pressure, the electrocardiographic pattern of left ventricular enlargement, obesity, and heavy cigarette usage. Sudden death is a common and possibly incidental expression of lethal coronary heart disease. The potential candidate for sudden death cannot be confidently distinguished from the individual who succumbs more slowly of myocardial infarction. The inescapable conclusion is that the prevention of sudden death requires the prevention of coronary attacks.
Cite This Study
Kannel et al. (1975) conducted a cohort in Sudden coronary death (n=4,120). Risk factors (high blood pressure, left ventricular enlargement, obesity, heavy cigarette usage) was evaluated on Sudden coronary death. Over 16 years, high blood pressure, left ventricular enlargement, obesity, and heavy smoking were positively correlated with sudden coronary death, which accounted for 109 of 234 CHD deaths.