[BITList] state of the nation

[CT's]

with such an at-risk population, there is no way the US can afford national health care..........................................

many just have to die.............

ct

For Men at 40, Risk of Cardiac Death 1 in 8 
  a.. By RON WINSLOW 
ORLANDO, Fla. -- Researchers said men at age 40 in the U.S. have a one-in-eight chance of suffering sudden cardiac death over the rest of their lives, a stark indication of the toll cardiovascular disease exacts on society.

For women, researchers said, the risk is 1 in 24. The prevalence has long been of concern to heart and public-health experts, but lifetime risks for the condition haven't previously been estimated, researchers said.

Some 300,000 Americans a year suffer sudden cardiac death, an event generally defined as death resulting from coronary heart disease within an hour of the onset of symptoms. Heart attack is the most common cause, but valve disease, infections and heart-beat irregularities can also result in sudden cardiac death.

"Sudden cardiac death is one of the most devastating manifestations" of coronary heart disease, said Donald M. Lloyd-Jones, a cardiologist at Northwestern University, Chicago, who led the effort to calculate the estimates. It is particularly problematic because "it strikes without warning" and can happen to young people as well as old, he said.

"It's fairly astonishing data," said Muriel Jessup, a cardiologist at University of Pennsylvania who headed the program committee for the American Heart Association's Scientific Sessions here, where the findings were presented Sunday, and who wasn't involved in the study.

The condition may get less attention because of a belief that little can be done to prevent it, she said. But she and other scientists said steps can be taken to prevent the problem.

Dr. Lloyd-Jones made the estimates by compiling information from three community-based longitudinal studies of heart disease. Among them was the Framingham Heart Study, the half-century-old project that has yielded information on how blood pressure, cholesterol and other factors increase risk of heart attack and other cardiovascular problems. The Cardiovascular Health Study, which focused on people 65 years old and over, and the Atherosclerosis Risk in Communities study, which has enrolled people ages 45 to 64, were the other data sources.

Among 2,261 men and 2,733 women in the Framingham study, for instance, researchers found 374 cases of sudden cardiac death. Based on that and data from the other studies, they calculated that at age 40, a man had a 12.3% chance of developing sudden cardiac death, while women had a 4.2% chance. For African-American men, the rate was higher than white men; there wasn't a difference between black and white women.

Dr. Lloyd-Jones noted that causes for sudden cardiac death, as in the case of heart attack, are largely preventable and include eating healthfully, quitting smoking and getting exercise as well as taking medicines when necessary to reduce blood pressure and cholesterol levels that are important risk factors for cardiovascular disease.

"This is the first time we've really seen these numbers," said Elliott Antman, a cardiologist at Brigham and Women's Hospital and Harvard Medical School, Boston. "This is a major public-health message. There is something you can do to reduce the risk."

Among the 300,000 annual cases, 3,000 to 5,000 occur among children, adolescents and young adults. In contrast to older adults, such cases are typically caused by a genetic mutation. How to identify people at risk because of their genes is the focus of much attention.

Michael Ackerman, an expert in the genetics of sudden cardiac arrest at the Mayo Clinic in Rochester, Minn., said that in about 50% of cases, warning signs -- including frequent episodes of dizziness or fainting, or an unexplained drowning or car accident involving a family member -- can indicate risk. "We can reduce sudden cardiac death right now just by being more aware of the warning signs," he said.
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