P-136: Do sudden death & fatal myocardial infarction have the same risk factors in primary prevention?

Abstract

Objectifs Sudden death, defined as a death which happens within 1 hour from the first symptom, is classified commonly as a coronary accident. Myocardial infarction is proposed as principal cause of sudden death. The frequency of sudden death is higher than that of fatal myocardial infarction. A recent overview showed that blood pressure lowering drugs did not decrease sudden death risk, whereas they decrease the risk of fatal myocardial infarction. We analyzed here the risk factors of sudden death and fatal myocardial infarction to provide more insight of the relation between these two accidents. Methodes We used Cox model to build the risk scores for two studied accidents on R (version 3.2.2), based on 15279 individual data in placebo group from seven randomized controlled trials (six of INDANA database in hypertension & one in type 2 diabetes Diahhycab). Resultats Sudden death and fatal myocardial infarction had the same five significant risk factors: age, sex (male), smoking, systolic blood pressure and type 2 diabetes history. Cholesterolemia was a significant predictor for fatal myocardial infarction but not for sudden death. Male sex and smoking displayed stronger associations with fatal myocardial infarction than sudden death, whereas type 2 diabetes history demonstrated the opposite tendency (Table 1). Table 1 . Comparison of risk factors of sudden death and of fatal myocardial infarction, using Cox model (maximum duration of follow up was 12 years) Sudden death Fatal myocardial infarction Hazard ratio p-value Hazard ratio p-value Age (5 years) 1.16 (1.11 – 1.22) 1.63e-10*** 1.18 (1.13 – 1.23) 1.97e-14*** Sex (male) 1.73 (1.18 – 2.54) 2.12 (1.52 – 2.97) 1.05-05*** Smoking 1.76 (1.26 – 2.45) 2.20 (1.66 – 2.93) 5.93e-08*** Systolic blood pressure (cm Hg) 1.05 (1.01 – 1.09) 0.026* 1.06 (1.02 – 1.10) History of type 2 diabetes 2.01 (1.23 – 3.26) 1.79 (1.17 – 2.75) Cholesterolemia (mmol/l) 1.10 (0.96 – 1.26) 0.166 1.20 (1.08 – 1.33) Conclusion In our trial database, sudden death and fatal myocardial infarction were associated with the same common cardiovascular risk factors.