The Sudden Cardiac Death Continuum. Message 2

INTRODUCTION. The study of the disease, including sudden cardiac death (SCD), as a consistent pathological process makes it possible to discover its mechanisms of formation, progression, and determine methods of prediction and prevention.

AIM OF THE STUDY. To determine the risk of developing SCD in the chain of events of the cardiorenal continuum (CRC) using the example of 7,959 initially healthy workers of locomotive crews of the Trans-Baikal Railway.

MATERIAL AND METHODS. Based on the material of a 6-year 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 for 22 positions. A 2×2 table and multivariate analysis were used, the relative risk of risk factors (RF) was estimated, and survival analysis was performed, which made it possible to construct a chronic kidney disease (CKD) continuum from the studied prepared symptomatic blocks: MAU, RP, CR, rGFR using the synthesis method, to which the SCD block was added according to this principle. In the Cox proportional hazard model, the hierarchical significance of predictors of SCD, CKD, and the increase in risk when predictors are added to the SCD continuum were determined.

RESULTS. The formation of SCD can occur from a risk factor from any peripheral point of the SCD continuum and depends on the set of risk factors, the proximity of the trigger to the outcome, its independent effect and (or) interaction with other risk factors. The most dangerous predictor of SCD is excessive alcohol consumption (EAC), causing damage to the heart and (or) kidneys, closing the dysfunctional circle of re-entry CRC, forming cardiorenal syndrome and the risk of events in the sequential chain of CRC:

EAC→^+2677%ВСС^+9367%↔^+10491%sGFR^+6660%↔^+3419%CR^+343%↔^+304%RP^+793%↔^+1257%MAU^+1486%←EAC. All other risk factors for SCD and CKD also worsen the condition and bring SCD closer.

CONCLUSION. Further research is needed into the continuum of sudden cardiac death to determine the primary nature of cardiac or renal involvement, the quantitative effects of risk factor damage, their increasing power with prolonged exposure, and the likelihood and timing of sudden cardiac death.

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