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Int J Angiol 2021; 30(04): 271-276
DOI: 10.1055/s-0041-1729629
Original Article

Sudden Cardiac Death in the General Population: Can We Improve Risk Stratification and Prevention?

Gary L. Murray
1   Department of Cardiology, The Heart and Vascular Institute, Germantown, Tennessee
,
Joseph Colombo
2   Department of Cardiology, Physio PS, INC, Atlanta, Georgia
3   Department of Cardiology, Autonomic Dysfunction and POTS Center, Sicklersville, New Jersey
› Author Affiliations Funding None.
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Abstract

A total of 15 to 20% of deaths worldwide are sudden (within 1 hour of symptom onset). Our ability to predict and prevent sudden cardiac death (SCD) in the general population, in which 85% have no known organic heart disease (OHD) or stable OHD with left ventricular ejection fraction >40%, is limited to poor. The purpose of this commentary is to suggest a new approach to SCD in this population. Oxidative stress is a common thread in development and progression of the major cardiac diseases associated with SCD. It has a profound adverse effect upon heart rate variability (HRV), sympathetic tone (S), and parasympathetic tone (P). Recently, developed technology finally has allowed accurate measures of S and P. Using this technique, the general population can be screened, those at risk for SCD can be identified with a higher degree of success, and preventative measures instituted. For example, in 133 geriatric type 2 diabetics with S and/or P abnormalities upon screening, the potent and natural antioxidant (r)α lipoic acid reduced SCD (relative risk reduction) 43% (p = 0.0076), mean follow-up 6.31 years. Diabetes mellitus patients have high glycemic oxidative stress. Addressing oxidative stress S and P abnormalities can reduce SCD. S and P screening of the general population will be discussed.

Keywords

sudden cardiac death - prevention - oxidative stress - α lipoic acid - diabetes - ventricular fibrillation - acute myocardial infarction


Publication History

Article published online:
19 July 2021

© 2021. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 Wellens HJ, Schwartz PJ, Lindemans FW. et al. Risk stratification for sudden cardiac death: current status and challenges for the future. Eur Heart J 2014; 35 (25) 1642-1651
    CrossrefPubMedSearch in Google Scholar
  • 2 Sessa F, Anna V, Messina G. et al. Heart rate variability as predictive factor for sudden cardiac death. Aging (Albany NY) 2018; 10 (02) 166-177
    CrossrefPubMedSearch in Google Scholar
  • 3 Aune D, Schlesinger S, Norat T, Riboli E. Diabetes mellitus and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 2018; 28 (06) 543-556
    CrossrefPubMedSearch in Google Scholar
  • 4 Ewing DJ, Campbell IW, Clarke BF. The natural history of diabetic autonomic neuropathy. Q J Med 1980; 49 (193) 95-108
    PubMedSearch in Google Scholar
  • 5 Spallone V, Ziegler D, Freeman R. et al; Toronto Consensus Panel on Diabetic Neuropathy. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev 2011; 27 (07) 639-653
    CrossrefPubMedSearch in Google Scholar
  • 6 Tsuji H, Larson MG, Venditti Jr FJ. et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 1996; 94 (11) 2850-2855
    CrossrefPubMedSearch in Google Scholar
  • 7 Rolo AP, Palmeira CM. Diabetes and mitochondrial function: role of hyperglycemia and oxidative stress. Toxicol Appl Pharmacol 2006; 212 (02) 167-178
    CrossrefPubMedSearch in Google Scholar
  • 8 Hussain N, Adrian TE. Diabetic neuropathy: update on pathophysiological mechanism and the possible involvement of glutamate pathways. Curr Diabetes Rev 2017; 13 (05) 488-497
    CrossrefPubMedSearch in Google Scholar
  • 9 Yorek MA. The role of oxidative stress in diabetic vascular and neural disease. Free Radic Res 2003; 37 (05) 471-480
    CrossrefPubMedSearch in Google Scholar
  • 10 Kalla M, Herring N, Paterson DJ. Cardiac sympatho-vagal balance and ventricular arrhythmia. Auton Neurosci 2016; 199: 29-37
    CrossrefPubMedSearch in Google Scholar
  • 11 Colombo J, Shoemaker WC, Belzberg H, Hatzakis G, Fathizadeh P, Demetriades D. Noninvasive monitoring of the autonomic nervous system and hemodynamics of patients with blunt and penetrating trauma. J Trauma 2008; 65 (06) 1364-1373
    CrossrefPubMedSearch in Google Scholar
  • 12 Murray GL, Colombo J. (r)Alpha lipoic acid is a safe, effective pharmacologic therapy of chronic orthostatic hypotension associated with low sympathetic tone. Int J Angiol 2019; 28 (03) 188-193
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Murray G, Colombo J. The feasibility of blood pressure control with autonomic-assisted hypertension therapy versus JNC 8 therapy. Clinical Cardiol Cardiovascular Med. 2020; 4: 1-5
    CrossrefPubMedSearch in Google Scholar
  • 14 Gomes MB, Negrato CA. Alpha-lipoic acid as a pleiotropic compound with potential therapeutic use in diabetes and other chronic diseases. Diabetol Metab Syndr 2014; 6 (01) 80-89
    CrossrefPubMedSearch in Google Scholar
  • 15 Gouty S, Regalia J, Cai F, Helke CJ. Alpha-lipoic acid treatment prevents the diabetes-induced attenuation of the afferent limb of the baroreceptor reflex in rats. Auton Neurosci 2003; 108 (1-2): 32-44
    CrossrefPubMedSearch in Google Scholar
  • 16 Eijgelsheim M, Aarnoudse AL, Rivadeneira F. et al. Identification of a common variant at the NOS1AP locus strongly associated to QT-interval duration. Hum Mol Genet 2009; 18 (02) 347-357
    CrossrefPubMedSearch in Google Scholar
  • 17 Rakhit A, Maguire CT, Wakimoto H. et al. In vivo electrophysiologic studies in endothelial nitric oxide synthase (eNOS)-deficient mice. J Cardiovasc Electrophysiol 2001; 12 (11) 1295-1301
    CrossrefPubMedSearch in Google Scholar
  • 18 Horinaka S, Kobayashi N, Yabe A. et al. Nicorandil protects against lethal ischemic ventricular arrhythmias and up-regulates endothelial nitric oxide synthase expression and sulfonylurea receptor 2 mRNA in conscious rats with acute myocardial infarction. Cardiovasc Drugs Ther 2004; 18 (01) 13-22
    CrossrefPubMedSearch in Google Scholar
  • 19 Hino Y, Ohkubo T, Katsube Y, Ogawa S. Changes in endothelium-derived vascular regulatory factors during dobutamine-stress-induced silent myocardial ischemia in patients with Kawasaki disease. Jpn Circ J 1999; 63 (07) 503-508
    CrossrefPubMedSearch in Google Scholar
  • 20 Aysin B, Colombo J, Aysn E. Comparison of HRV analysis methods during orthostatic challenge: HRV with respiration or without?. 29th Int Conf IEEE EMBS 2007, Lyon, France. Accessed 2007 at: https://pubmed.ncbi.nlm.nih.gov/18003140/
  • 21 Akselrod S, Gordon D, Ubel FA, Shannon DC, Berger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 1981; 213 (4504): 220-222
    CrossrefPubMedSearch in Google Scholar
  • 22 Akselrod S, Gordon D, Madwed JB, Snidman NC, Shannon DC, Cohen RJ. Hemodynamic regulation: investigation by spectral analysis. Am J Physiol 1985; 249 (4 Pt 2): H867-H875
    PubMedSearch in Google Scholar
  • 23 Akselrod S, Eliash S, Oz O, Cohen S. Hemodynamic regulation in SHR: investigation by spectral analysis. Am J Physiol 1987; 253 (1 Pt 2): H176-H183
    PubMedSearch in Google Scholar
  • 24 Akselrod S. Spectral analysis of fluctuations in cardiovascular parameters: a quantitative tool for the investigation of autonomic control. Trends Pharmacol Sci 1988; 9 (01) 6-9
    CrossrefPubMedSearch in Google Scholar
  • 25 Murray G, Colombo J. Routine measurements of cardiac parasympathetic and sympathetic nervous systems assists in primary and secondary risk stratification and management of cardiovascular clinic patients. Clinical Cardiology and Cardiovascular Medicine. 2019; 3 (01) 27-33
    CrossrefPubMedSearch in Google Scholar
  • 26 Murray GL, Colombo J. Maintenance (r) alpha lipoic acid reduces sudden cardiac death in geriatric diabetes mellitus II patients. Clinical Cardiol Cardiovascular Med. 2020; 4: 6-11
    CrossrefPubMedSearch in Google Scholar
  • 27 DePace N, Colombo J. Autonomic and Mitochrondrial Dysfunction in Clinical Diseases: Diagnostic, Prevention, and Therapy. New York, NY: Springer Science+Business Media; 2019
    CrossrefSearch in Google Scholar
  • 28 Murray GL, Colombo J. Ranolazine therapy reduces non-ST-segment elevation myocardial infarction and unstable angina in coronary artery disease patients with angina. Int J Angiol 2016; 25: 150-164
    PubMedSearch in Google Scholar
  • 29 Murray GL, Colombo J. Ranolazine preserves and improves left ventricular ejection fraction and autonomic measures in congestive heart failure when added to guideline-driven therapy. Heart Int 2014; 9 (02) 66-73
    PubMedSearch in Google Scholar
  • 30 Curtis BM, O'Keefe Jr JH. Autonomic tone as a cardiovascular risk factor: the dangers of chronic fight or flight. Mayo Clin Proc 2002; 77 (01) 45-54
    CrossrefPubMedSearch in Google Scholar
  • 31 Kucharska-Newton AM, Couper DJ, Pankow JS. et al. Diabetes and the risk of sudden cardiac death, the Atherosclerosis Risk in Communities study. Acta Diabetol 2010; 47 (Suppl. 01) 161-168
    CrossrefPubMedSearch in Google Scholar