Factors related to suddenness of death from coronary disease: combined Albany-Framingham studies

One hundred nine sudden deaths in men 45 to 74 years of age enrolled in prospective studies in Albany, N. Y. and Framingham, Mass. were examined in an effort to identify features associated with sudden death from coronary heart disease. From a coronary profile made up of serum cholesterol concentration, systolic blood pressure, relative body weight, cigarette habit and electrocardiographic evidence of left ventricular enlargement, the likelihood of sudden death could be estimated over a 14-fold range of risk. One third of sudden deaths occurred in men in the topmost decile of risk, but whether or not death from coronary disease was sudden was largely unrelated to the mix of risk factors. The proportion of such deaths that were sudden was equal among men with and without prior overt coronary heart disease. Increasing age was not conclusively associated with the suddenness of death. No combination of risk factors considered separated persons uniquely destined to die suddenly from those who would experience a more protracted death. It is conjectured that sudden death from coronary disease is related more to the exact nature of the pathologic changes in the heart than to the factors predisposing to these changes. The prevention of sudden death from coronary disease requires correction of the antecedents of coronary attacks.