Young, Obese, and 'At Risk' for Sudden Cardiac Death
Any risk factor that heightens the possibility of death at a young age should warrant attention and prevention, when possible. A 2018 study has exposed some causes of sudden cardiac death in young people and underscores an escalated focus on screening and prevention.
To be clear, sudden cardiac death is not synonymous with a heart attack. Sudden cardiac death or arrest is the result of sudden, defective electrical activity in the heart, often with little warning. A heart attack or myocardial infarction is typically caused by clogged coronary arteries, causing reduced blood flow to the heart. Early symptoms before a heart attack are often present.
Studying unexpected death
The Oregon Sudden Unexpected Death Study prospectively enrolled approximately 1 million subjects between the ages of 5 and 34 in Portland, Oregon, between 2002 and 2015. The prevention of sudden cardiac death is considered a public health challenge and it’s of particular concern when it occurs in younger people.
This study gathered information about people who experienced sudden cardiac death (SCD), also called sudden cardiac arrest (SCA) including: circumstances of death, resuscitation outcomes, and emergency response records, as well as clinical health records and autopsy reports. The researchers honed in especially on “standard heart risk factors” associated with SCD and how sports was (or wasn’t) a specific trigger of SCD.
Some findings of the study included:
- Women, compared to men, have fewer cardiac structure abnormalities and lower recognized coronary disease before cardiac arrest occurs.
- Less than one-third of the cases of SCD noted in the study would have been classified as “high risk” prior to the event.
- Certain markers on ECG, including prolonged QT interval, prolonged QRS duration, and increased T-peak to T-end interval, increase the risk of SCD in the general population
- Having an increased left ventricular mass increases the risk of SCD, independent of left ventricular function.
Out of 3775 people who experienced SCD, 186 (or 5 percent) of the events occurred among younger people (under age 35). Among those 186 younger people, warning signs were very low (29 percent), and 26 people (14 percent) had a sports interaction that triggered the SCD.
More specifically by age, sports-related SCD accounted for 39 percent of SCDs in those under age 18, 13 percent in ages 19 through 25, and 7 percent in ages 25 through 34. Among the 186 younger people, 160 had non-sports related triggers or risks associated with SCD. The most common SCD-related conditions included sudden arrhythmic death syndrome (31 percent), coronary artery disease (22 percent), and hypertrophic cardiomyopathy (14 percent).
Major cardiovascular risk factors in young people
Sports was clearly a trigger of SCD, but in a much smaller number of subjects, and as previously mentioned, researchers noted that SCD occurred without warning signs in most of the subjects. What was quite notable was the “high presence” of standard cardiovascular risk factors among the young SCD victims in the study.
These risk factors were found in close to 60 percent of the young subjects and included:
- High cholesterol
The lead researcher of one arm of the study, Sumeet S. Chugh, MD, associate director of the Cedars-Sinai Heart Institute in Los Angeles, CA, has suggested that obesity may play a much larger role in SCD among young people, than previously thought. If you look at these five risk factors, it’s clear that they are identifiable and preventable. Screenings and follow up screenings through childhood and teen years would likely note these risk factors and focused lifestyle interventions might help to lower overall rates of heart disease in the younger population and potentially limit the rates of SCD in young adulthood.
Obesity prevention and minimizing SCD risks
Sudden cardiac death often hits the news cycle when it occurs in a young athlete. We associate being athletic with being healthier, hence the shock these headlines tend to garner. Based on this study, we should be concerned with intercepting risk factors that can be minimized and prevented.
In 2015, the American Academy of Pediatrics (AAP) released a clinical report describing the need for pediatricians to be an integral part of obesity prevention efforts, given the rates of childhood and teen obesity in the U.S. The AAP also recommended practical steps to help families raise healthy children and limit the risk of obesity. This study suggests that these efforts are still crucial and maybe even more necessary now that we recognize the link with SCD in young people.
Based on the findings of this study, it is critical that we prevent and limit risk factors linked to SCD. Currently, children are developing obesity, high blood pressure, diabetes, high cholesterol, and metabolic syndrome at younger and younger ages. Intercepting these conditions requires regular screenings and more engagement with parents to help guide better home health, nutrition, and fitness practices.
To accomplish those goals the public health sector needs to make “SCD in the young” a focal point of community health programs. Pediatricians should continue to team up with parents and school educators to help initiate better nutrition and fitness efforts and to provide and support lifestyle education at home and in schools. Sudden cardiac death in the young caused by modifiable risk factors is simply unacceptable. Let’s reverse the trend.
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