Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Preventing Sudden Cardiac Death in the Young

Circulation; ePub 2017 Dec 21; Jayaraman, et al

Incidence of sudden cardiac arrest (SCA) occurs without warning symptoms in young participants, with sports a trigger in only a minority of cases and standard cardiovascular risk factors found in over half of patients, a recent study found. The prospective study included participants who suffered SCA between ages 5-34 years in the Portland, OR, area between 2002 and 2015. Researchers evaluated the association of standard CV risk factors and SCA, and sports as a trigger for SCA in the young. They found:

  • Of 3,775 SCAs in all age groups, 186 (5%) occurred in the young (mean age ∼26 years, 67% male).
  • In young SCA, overall prevalence of warning signs before SCA was low (29%); and only 26 (14%) were associated with sports as a trigger.
  • The remainder (n=160) occurred in other settings categorized as non-sports.
  • Sports-related SCAs accounted for 39% of SCAs aged ≤18 years, 13% of SCAs aged 19-25 years, and 7% of SCAs aged 25-34 years.
  • Overall, the most common SCA-related conditions were sudden arrhythmic death syndrome (31%), coronary artery disease (22%), and hypertrophic cardiomyopathy (14%).
  • There was a high overall prevalence of established CV risk factors with ≥1 risk factor in 58% of SCA cases.

Citation:

Jayaraman R, Reinier K, Nair S, et al. Risk factors of sudden cardiac death in the young: A multiple-year community-wide assessment. [Published online ahead of print December 21, 2017]. Circulation. doi:10.1161/CIRCULATIONAHA.117.031262.

Commentary:

SCA remains a vexing problem with tragic outcomes and very little data available to identify high-risk groups ahead of time. The current study is important in showing that participation in sports accounts for only a minority of SCA in young people. The unanswered question for SCA in the young is whether screening can be effective, through a combination of physical exam—which primarily looks to detect a murmur associated with hypertrophic cardiomyopathy—and EKG, to look for long QT syndrome. Currently such screening is not standard and is the subject of much research.1—Neil Skolnik, MD

  1. Ackerman M, et al. Sudden cardiac death in the young. Circulation. 2016;133:1006-1026. doi:10.1161/CIRCULATIONAHA.115.020254.

This Week's Must Reads

USPSTF: Screening for Intimate Partner Violence, JAMA; 2018 Oct 23/30; US Preventive Services Task Force

High HbA1c Variability and Risk of MACE, Diabetes Care; ePub 2018 Oct 23; Ghouse, et al

Omega 3 Polyunsaturated Fatty Acids & Healthy Aging, BMJ; ePub 2018 Oct 17; Lai, Otto, et al

Gaps in HIV PrEP by Race and Ethnicity, MMWR; 2018 Oct 19; Huang, Zhu, et al

Kidney Damage Biomarkers & Incident CKD in BP Reduction, Ann Intern Med; ePub 2018 Oct 23; Zhang, et al

Must Reads in Cardiology

Omega 3 Polyunsaturated Fatty Acids & Healthy Aging, BMJ; ePub 2018 Oct 17; Lai, Otto, et al

Kidney Damage Biomarkers & Incident CKD in BP Reduction, Ann Intern Med; ePub 2018 Oct 23; Zhang, et al

Excess Hypertension Risk in Black Adults, JAMA; 2018 Oct 8; Howard, Cushman, et al

Prescription NSAID Use in High-Risk Patients, JAMA Intern Med; ePub 2018 Oct 8; Bouck, et al

Wearable Cardioverter-Defibrillator Use After MI, N Engl J Med; 2018 Sep 27; Olgin, et al