Risk and Protective Factors for Sudden Cardiac Death: An Umbrella Review of Meta-Analyses

Abstract

BackgroundSudden cardiac death (SCD) is a global public health issue, accounting for 10–20% of deaths in industrialized countries. Identification of modifiable risk factors may reduce SCD incidence.MethodsThis umbrella review systematically evaluates published meta-analyses of observational and randomized controlled trials (RCT) for the association of modifiable risk and protective factors of SCD.ResultsFifty-five meta-analyses were included in the final analysis, of which 31 analyzed observational studies and 24 analyzed RCTs. Five associations of meta-analyses of observational studies presented convincing evidence, including three risk factors [diabetes mellitus (DM), smoking, and early repolarization pattern (ERP)] and two protective factors [implanted cardiac defibrillator (ICD) and physical activity]. Meta-analyses of RCTs identified five protective factors with a high level of evidence: ICDs, mineralocorticoid receptor antagonist (MRA), beta-blockers, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with HF. On the contrary, other established, significant protective agents [i.e., amiodarone and statins along with angiotensin-converting enzyme (ACE) inhibitors in heart failure (HF)], did not show credibility. Likewise, risk factors as left ventricular ejection fraction in HF, and left ventricular hypertrophy, non-sustain ventricular tachycardia, history of syncope or aborted SCD in pediatric patients with hypertrophic cardiomyopathy, presented weak or no evidence.ConclusionsLifestyle risk factors (physical activity, smoking), comorbidities like DM, and electrocardiographic features like ERP constitute modifiable risk factors of SCD. Alternatively, the use of MRA, beta-blockers, SGLT-2 inhibitors, and ICD in patients with HF are credible protective factors. Further investigation targeted in specific populations will be important for reducing the burden of SCD.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020216363, PROSPERO CRD42020216363.

Anti-Arrhythmic Effects of Heart Failure Guideline-Directed Medical Therapy and Their Role in the Prevention of Sudden Cardiac Death: From Beta-Blockers to Sodium-Glucose Cotransporter 2 Inhibitors and Beyond

“…A large retrospective registry by Schupp et al [ 43 ] indicated that ACEI/ARB treatment is associated with reduced all-cause mortality in patients who survived episodes of VA. Nonetheless, meta-analyses have shown a lack of a consistent efficacy of ACEi/ARBs in reducing the risk of SCD and VA, despite demonstrating benefits in overall mortality and hospitalization rates [ 30 , 44 , 45 , 46 ]. The exception appears to be in the context following acute myocardial infarction, where ACEi have shown a 20% reduction in SCD [ 47 ].…”

Sudden Cardiac Death in Young Individuals: A Current Review of Evaluation, Screening and Prevention

“…A case-control study performed in Korea found that healthy lifestyle factors, specifically lesser intake of red meat or fish, higher intake of fruits or vegetables, non-smoking, regular physical exercise, and adequate sleep showed a protective effect against sudden cardiac arrest (SCA) [ 28 ]. Similarly, an umbrella review of meta-analyses concluded that current smoking is an important risk factor, whereas physical activity is an important protective factor [ 29 ]. A prospective study on smoking in women found a 2.46-fold increased risk of SCD in current smokers, with a decreased risk over time after quitting, overall concluding a strong dose-response relationship between cigarette smoking and SCD risk [ 30 ].…”

Sudden Cardiac Death: An Update on Commotio Cordis

“…When the death is not witnessed, the “sudden” period extends to 24 hours. SCD can be the first presentation of cardiovascular disease, and almost half of all SCD victims have no previously diagnosed heart condition [ 16 ]. In the past two decades, cardiovascular-related deaths have become less common in developed countries, especially in individuals with risk factors for SCD such as CAD and heart failure (HF).…”