The Sudden Cardiac Death Continuum. Message 1

RELEVANCE Many clinical conditions are considered in a sequence of interrelated events of the continuity of the pathological process. This makes it possible to discover its patterns, specific mechanisms of occurrence and development of the disease. However, the continuum of sudden cardiac death (SCD) remains unknown.

AIM OF THE STUDY To clarify the sequence of events of the continuum of the SCD using the example of initially healthy workers of locomotive crews of the Trans-Baikal Railway.

MATERIAL AND METHODS Based on the material of a 6-year prospective observation of a natural group of 7,959 men aged 18–66 years, predictors of microalbuminuria (MAU), creatininemia (CR), reduced glomerular filtration rate (rGFR), retinopathy (RP), and SCD were determined in 22 positions. A 2×2 table, multivariate regression analysis, and survival analysis were used, and the relative risk of risk factors (RF) was estimated, which made it possible to study and construct a continuum of chronic kidney disease from pre-prepared symptomatic blocks: MAU, RP, CR, rGFR using the synthesis method based on the principle of assembling puzzles, to which the SCD block was added according to this principle.

RESULTS The formation of SCD depends on the set of risk factors in each individual case and can occur from any peripheral point of the SCD continuum (from the risk factor). The formation of SCD is determined by the proximity of the predictor to the outcome, its independent effect and (or) interaction with other risk factors. The most dangerous predictor of SCD is excessive alcohol consumption, which causes damage to the heart and (or) kidneys, closing the dysfunctional circle of re-entry cardiorenal continuum and forming cardiorenal syndrome. In the population, those most at risk of SCD are those with an initially low number of nephrons and (or) a congenital defect of the microcirculatory bed.

CONCLUSION Further study of the continuum of sudden cardiac death is needed to determine whether cardiac or renal involvement is primary and whether the risk of sudden cardiac death increases. cardiac death when each predictor is added to the continuum of sudden cardiac death, the effects of risk factor damage, their increasing power with prolonged exposure, the magnitude of tissue damage, and the probability and timing of sudden cardiac death.

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