Sudden Cardiac Death In Women Research Articles

Physical Exertion, Exercise, and Sudden Cardiac Death in Women

Physical Exertion, Exercise, and Sudden Cardiac Death in Women

Moderate to Vigorous Exertion and Sudden Cardiac Death in Women

Moderate to Vigorous Exertion and Sudden Cardiac Death in Women

Regular Moderate Exercise Prevents Sudden Cardiac Death in Women

Regular Moderate Exercise Prevents Sudden Cardiac Death in Women

Physical Exertion, Exercise, and Sudden Cardiac Death in Women

Exercise is associated with a lower risk of cardiovascular events but may transiently increase the risk of ventricular arrhythmias. Its short-term and long-term associations with risk of sudden cardiac death among women are unclear. To compare the risk of sudden cardiac death in women during moderate to vigorous exertion with the risk of sudden cardiac death during lighter or no exertion; and to assess the long-term association between moderate to vigorous exercise and sudden cardiac death. Prospective, nested case-crossover study of 288 cases of sudden cardiac death within the Nurses' Health Study (1980-2004); and a prospective cohort analysis of 69,693 participants without prior cardiovascular disease followed up from 1986-2004. Risk of sudden cardiac death associated with moderate to vigorous exertion. The absolute risk of sudden cardiac death associated with moderate to vigorous exertion was exceedingly low at 1 per 36.5 million hours of exertion. In case-crossover analyses, the risk of sudden cardiac death was transiently elevated during moderate to vigorous exertion (relative risk [RR], 2.38; 95% confidence interval [CI], 1.23-4.60; P = .01) compared with the risk during lesser or no exertion. Habitual moderate to vigorous exertion modified this transient risk (P = .005 for interaction) and the risk was no longer significantly elevated among those who exercised 2 or more hours per week. In the cohort analyses, an increasing amount of moderate to vigorous exercise was associated with a lower long-term risk of sudden cardiac death in age-adjusted and multivariable models that excluded biological intermediates (P = .006 for trend). This relationship was attenuated when biological intermediates were included (P = .06 for trend); however, the reduction in risk remained significant among women who exercised 4 or more hours per week (adjusted RR, 0.41; 95% CI, 0.20-0.83; P = .01) compared with women who did not exercise. These prospective data suggest that sudden cardiac death during exertion is an extremely rare event in women. Regular exercise may significantly minimize this small transient risk and may lower the overall long-term risk of sudden cardiac death.

Learning More About Risk for Sudden Cardiac Death in Women

Although sudden cardiac death (SCD) is about one third as common in women as in men, its frequency has been reported to be increasing in women but

Prospective study of sudden cardiac death among women in the United States.

There are few data regarding the determinants of sudden cardiac death (SCD) in women, primarily because of their markedly lower rate of SCD compared with men. Nonetheless, existing data, although sparse, suggest possible gender differences in risk factors for SCD. In this prospective cohort of 121 701 women aged 30 to 55 years at baseline, SCD was defined as death within 1 hour of symptom onset. From 1976 to 1998, 244 SCDs were identified. Although the risk of SCD increased markedly with age, the percentage of cardiac deaths that were sudden decreased. Most (69%) women who suffered a SCD had no history of cardiac disease before their death. However, almost all of the women who died suddenly (94%) had reported at least 1 coronary heart disease risk factor. Smoking, hypertension, and diabetes conferred markedly elevated (2.5- to 4.0-fold) risk of SCD, similar to that conferred by a history of nonfatal myocardial infarction (relative risk, 4.1; 95% confidence interval, 2.9 to 6.7). Family history of myocardial infarction before age 60 years and obesity were associated with moderate (1.6-fold) elevations in risk. With regard to mechanism, 88% of SCDs were classified as arrhythmic. In 76% of these, the first rhythm documented was ventricular tachycardia or ventricular fibrillation. These prospective data suggest that, as in men, coronary heart disease risk factors predict risk of SCD in women and that SCD is usually an arrhythmic death. Therefore, prevention of atherosclerosis or ventricular arrhythmias may reduce the incidence of SCD in women.

Gender Difference in the Risk Factors for Sudden Cardiac Death

Sudden cardiac death is most often caused by ventricular dysrhythmias. Although women have an incidence of sudden death lower than that of men, 34% of coronary deaths in women are sudden deaths. The atherogenic risk factors do not predict which women are at the highest risk of sudden cardiac death. Left ventricular hypertrophy is a strong risk factor for sudden cardiac death in women. Asymptomatic ventricular dysrhythmias, a risk factor for death after myocardial infarction in men, do not increase the risk of death in women. This gender difference in the risk of sudden cardiac death deserves further attention, since it affects the evaluation of interventions designed to reduce the rate of sudden cardiac death.

Environmental events preceding sudden death in women.

The present case-control study examined if sudden cardiac death in women is preceded by death of a significant other, change in residence, or change in work. The sample included 81 Caucasian women ages 25-64 years in Allegheny County, Pennsylvania, who died suddenly from arteriosclerotic heart disease (ASHD) within a 11/2 year interval. Each case was matched to a neighborhood control on the basis of race, age, and sex. Results revealed that relative to matched controls, cases were six times as likely to have experienced the death of a significant other within the last months; they were no more likely to have experienced changes in living conditions or in work. These findings raise the issue of whether death of a significant other is an antecedent event of death due to ASHD only or death due to all causes. Possible explanations for the temporal association between sudden death and death of a significant other are discussed.