Are You at Risk of Dropping Dead From a Heart Attack?

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Man Experiencing Chest Pain Many of us have heard stories about someone who is seemingly in good health suddenly dropping dead from a heart attack. The abrupt end to a life is shocking, especially when there were no indications that the person suffered from heart trouble.

And when these unexpected events hit close to home and happen to a family member, friend or acquaintance, it is natural for us to ask ourselves, “Could this happen to me?” Medical researchers’ answer to this question would be, “Yes, it can.”

For example, one recent study found 67 percent of sudden cardiac deaths among 660,000 Oregon adults followed in the study occurred in people who were not previously diagnosed with poor heart function.[1]

Another recent study following over 120,000 registered nurses found 69 percent of women in the study population who experienced sudden cardiac death had no history of cardiac disease before their death.[2]

While the prevalence of previously diagnosed heart disease in sudden cardiac death events is higher in men, a near majority of men in other studies who died suddenly from heart attacks (45 percent to 55 percent depending on the study chosen) had no prior history of heart disease.

And it’s not just a matter of age. One would think the risk of sudden cardiac death would not be associated with young people, but that’s not the case. According to a recent study of sudden deaths in Canadian adults under the age of 40, sudden cardiac death was responsible for 80 percent of the overall sudden deaths of those aged 31-40, and 37 percent of all sudden deaths of those between the ages of 21 and 30.[3]

If there’s no history of heart disease, how do you know the “big one” is coming?

It’s a good question. While it’s certainly true that a diagnosis of chronic heart disease is strongly linked to the risk of a sudden heart attack, the above study findings indicate that a majority of adults who die from unexpected heart failure have not been diagnosed with chronic heart disease.

In peeling the onion further to look at the cardiovascular disease risk factors that reasonably predict the potential for developing chronic heart disease — high cholesterol, high blood pressure, obesity and diabetes — scientists find strong correlations between the presence of these conditions and elevated risk for sudden cardiac death, regardless of whether chronic heart disease itself has been diagnosed.

And so all manner of research has been conducted to develop prescription medications that control cholesterol, blood pressure, blood sugar and weight. But the sad truth is that while these medications can make meaningful diagnostic differences for their intended purposes, they do not appear to significantly reduce the risk of sudden cardiac death.

In peeling back the onion yet one more layer, researchers have found strong correlations between the risk of sudden cardiac death and four lifestyle behavior choices that lead to the cardiovascular disease risk factors highlighted above:

1. Smoking
2. Abstinence or overuse of alcohol
3. Physical inactivity
4. Poor diet

Specifically, scientists have found strikingly lower incidence of sudden cardiac death among people who exhibit the following behaviors (regular readers of Peak Health Advocate will note these lifestyle behaviors are at the core of our recommended health philosophy):

  • Exercise regularly: 3-6 hours per week of moderate-intensity activity
  • Consume alcohol in moderation: 1-3 alcoholic beverages per day
  • Consume a majority of daily calories from foods commonly found in a Mediterranean-style diet: raw fruits and vegetables, fish and poultry, nuts, legumes, olive oil, whole grains
  • Refrain from smoking cigarettes

For example, a new study published this month in the Journal of the American Medical Association reported that women in the study who practiced excellent habits in all four of these lifestyle behaviors experienced 92 percent less incidence of sudden cardiac arrest than women in the study who practiced poor health habits in all four lifestyle categories. The only problem with this finding is that a mere 8 percent of the 82,000 women in the study fell into the “excellent” lifestyle behavior category! Women who were “excellent” in at least two of the four lifestyle behaviors (about 60 percent of the study population) still experienced 20 percent to 40 percent less sudden cardiac deaths compared to women who were “poor” in their practices in all four lifestyle behaviors.[4]

An earlier study examining lifestyle behaviors and the risk of incurring heart failure among men found 52 percent lower incidence of heart failure in those who exhibited excellent practices in at least four of six lifestyle behaviors examined in the study (the same health factors examined in the above mentioned women’s study with dietary-related factors broken out into more than one category in the men’s study). By the way, only 12 percent of the men’s study participants practiced excellent habits in at least four of the six factors examined in the study. As in the women’s study above, men who practiced at least two of the lifestyle behaviors at an “excellent” level experienced 20 percent to 40 percent lower incidences of heart failure (representing about 70 percent of the men in the study).[5]

While the men’s study of heart failure incidence does not precisely translate to sudden cardiac death (many people with heart failure have survived the heart attack), the general point holds. Other studies have shown that adopting a healthier lifestyle not only reduces the risk of cardiovascular disease, it also lowers the risk of sudden cardiac death in both men and women.

Is it too late to make lifestyle changes if you’ve already developed cardiovascular risk factors or cardiovascular disease?

Nope. As we’ve previously written, the human body demonstrates a remarkable willingness to heal if provided with the right inputs. As a case in point, a 2007 study of men aged 45-64 found that those in the study who adopted a healthier lifestyle (defined as not smoking, exercising regularly, eating five more servings of fruits/vegetables per day, and consuming moderate alcohol daily) achieved significant risk reductions in cardiovascular disease and all-cause deaths in comparison to those in the study who continued to practice poor health habits.[6]

In fact, the middle-aged “new lifestyle adopters” lowered their all-cause mortality risk by 40 percent and their risk of a cardiac event by 35 percent in just four years. Those are pretty impressive improvements from self-directed changes that didn’t require prescription medications or other medical interventions – just a commitment to engage in a healthier lifestyle.

So whether you are a man or women, young or old, following a healthy lifestyle today or not, you can make a meaningful difference in your risk of sudden cardiac death and cardiovascular disease by simply taking steps each day to eat healthier foods, increase physical activity, consume moderate amounts of alcohol and cut out/reduce exposure to cigarette smoke.

While we all may not be able to rise to the level of the 8 percent to 12 percent “excellent” healthy lifestyle practicers highlighted in the above studies, we surely can make significant strides to cut our risk of cardiovascular disease, sudden cardiac death and all-cause mortality with each step in the right direction.

[1] Stecker EC, et al. Population-based analysis of sudden cardiac death with and without left-ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study. J Am Coll Cardiol. 2006 March 21; 47(6)”: 1,161-66.

[2] Albert CM, et al. Prospective study of sudden cardiac death among women in the United States. Circulation. 2003 April 29; 107(16): 2,096-101.

[3] Arzamendi D, et al. Increase in sudden death from coronary artery disease in young adults. Am Heart J. 2011 March; 161(3): 574-580.

[4] Chiuve SE, et al. Adherence to a Low-Risk, Healthy Lifestyle and Risk of Sudden Cardiac Death Among Women. JAMA. 2011 July 6; 306(1); 62-69.

[5] Djousse L, et al. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009 July 22; 302(4); 394-400.

[6] King DE, et al. Turning back the clock: adopting a healthy lifestyle in middle age. Am J Med. 2007 Jul; 120(7): 598-603.

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