JACC：绝经后女性发生心源性猝死的相关危险因素

与心肌梗死和脑卒中不同，心源性猝死（sudden cardiac death，SCD）的危险因素目前还不明确，也很难去进行研究，其主要原因是SCD的定义不统一。在美国，每年有30-35万人发生心源性猝死，年发病率达0.1-0.2%。虽然SCD的发生率远低于心肌梗死和脑卒中，但SCD造成的死亡却占美国人口自然死亡的13%，约一半的冠心病患者表现为SCD，是美国人死亡的首要原因。

绝经后女性是心血管疾病的高发人群，也是SCD发生的高危人群，然而对于绝经后女性发生SCD的危险因素目前还不明确，一些研究表明，对于绝经后女性，现有的冠心病危险因素并不能预测SCD，且随着冠心病危险因素得到明显控制，男性患者SCD的发生明显减少，而女性却减少不明显。据此，Bertoia ML等进行了一项大规模的临床调查研究，旨在探讨绝经后女性发生SCD的相关危险因素。

研究共入选161808名绝经后女性，入选时间自1993年至1999年，所有患者随访至2009年8月，主要终点时间为SCD，SCD定义为症状发生后1小时内出现的死亡或他人在1小时内见到无症状的患者的死亡，除外致死性非冠心病的患者。结果显示：共有418例患者出现SCD，比例为0.024%。通过分析确定SCD发生的独立预测因素有：高龄、黑种人、吸烟、压力大、腰围-臀围比值高、白细胞升高、心衰病史、糖尿病、既往有心肌梗死、既往有颈动脉疾病和高血压。人群归因分数最大的危险因素是高血压、腰围-臀围比值高和心肌梗死病史。

通过该项研究可得出以下结论：除了传统的冠心病危险因素外，绝经后女性发生SCD的危险因素还包括：黑种人、压力大、腰围-臀围比值高、白细胞升高和心衰。接近一半的患者发生SCD前并未诊断冠心病。

与心源性猝死相关的拓展阅读： 

• 冠脉疾病所致心源性猝死前常见心脏症状
• JAMA：心肌纤维化是扩张型心肌病患者发生心源性猝死的独立预测因素
• 磁共振对预测缺血性心肌病患者并发心源性猝死的原理和应用价值 更多信息请点击：有关心源性猝死更多资讯

Risk Factors for Sudden Cardiac Death in Post-Menopausal Women
Objectives
The aim of this study was to estimate the annual incidence rate of sudden cardiac death (SCD) and to identify risk factors for SCD in post-menopausal women. Background With the aging U.S. population, post-menopausal women now have the greatest population burden of cardiovascular disease including SCD.
Methods
We examined 161,808 women who participated in the Women's Health Initiative clinical trials and observational study. The women were recruited at 40 clinical sites across the United States, enrolled between 1993 and 1998, and followed until August 2009. Our primary endpoint is incident SCD, defined as death occurring within 1 h of symptom onset or within 1 h after the participant was last seen without symptoms and death that occurred in the absence of a potentially lethal non-coronary disease process.
Results
Four hundred eighteen women experienced adjudicated SCD. The incidence rate of SCD was 2.4/10,000 women/year (95% confidence interval: 2.2 to 2.7). We identified the following independent risk factors for SCD: older age, African-American race, tobacco use, higher pulse, higher waist-to-hip ratio, elevated white blood cell count, history of heart failure, diabetes, history of myocardial infarction, previous carotid artery disease, and hypertension. Population-attributable fractions were greatest for hypertension, waist-to-hip ratio, and myocardial infarction.
Conclusions
Besides traditional risk factors for coronary heart disease, risk factors for sudden cardiac death in post-menopausal women include African-American race, higher pulse, higher waist-to-hip ratio, elevated white blood cell count, and heart failure. Nearly one-half of women who experienced sudden cardiac death had no previous diagnosis of coronary heart disease.