Editorial: Ideal cardiovascular health and sudden cardiac death

Ideal cardiovascular health (CVH) is a strategic impact goal established by the American Heart Association (AHA), which was designed to improve the CVH of all Americans by 20% and reduce deaths from cardiovascular disease by 20% in 2020. The AHA defined ideal CVH as achieving four lifestyle factors (non-smoking, body mass index (BMI) <25 kg/m2, physical activity at goal, and optimal diet consistent with guidelines), and three biometric factors (untreated total cholesterol <200 mg/dl, untreated fasting blood glucose <100 mg/dl, and untreated blood pressure <120/80 mm Hg).1 Sudden cardiac death (SCD), defined as death due to cardiac causes, primarily as a result of fatal arrhythmia, is the most common cause of mortality worldwide, accounting for 50% of deaths from cardiovascular disease.2 Coronary artery disease, cardiomyopathies, congestive heart failure, hereditary and mutations of cardiac ion channel genes are the most prevalent causes. Disorder of the autonomic nervous system control of the cardiovascular system is the dominating pathological mechanism.3 Although the implantable cardioverter defibrillator has been applied for primary and secondary prevention, which mainly focuses on risk reduction in later life between the survivors and high-risk patients, early life prevention and prediction of SCD is still challenging. Recently, a review discussed cardiovascular risk factors which should be noted from the preconceptional phase to the last frail stages of life, and suggested that healthy lifestyle habits should be initiated from infancy and maintained during the whole lifetime to avoid SCD.4 Achieving more ideal CVH metrics is associated with a lower risk of incident cardiovascular disease, stroke, and other related metabolic diseases, such as hypertension and type 2 diabetes.5,6–7 However, the association of ideal CVH from early life and SCD is still not fully assessed. Here, a prospective population-based cohort study in 2577 middle-aged men with a median follow-up period of 25.8 years revealed that men with an ideal CVH score (5–7) had 85% reduced risk of SCD and 67% lower risk of all-cause mortality when compared with those with a poor CVH score (0–2) in a multivariable analysis. The risk of SCD and all-cause mortality decreased continuously with increasing score of CVH metrics across the range 2–7.8 This study emphasizes that ideal CVH metrics are strongly inversely associated with the risk of SCD and all-cause mortality. Early intervention for ideal CVH is anticipated to further reduce the residual risk of SCD. However, the prevalence of ideal CVH was reported to be low in American adults aged ≥20 years old, with the percentage at about 20%.9 Therefore, it is important to effectively guide more people to achieve the ideal CVH metrics. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) received no financial support for the research, authorship, and/or publication of this article. The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.