The Sudden Cardiac Death Continuum. Message 3

BACKGROUND Endothelial dysfunction (ED), formed under the influence of risk factors (RF), is the leading link in the pathogenesis of cardiovascular diseases (CVD), sudden cardiac death (SCD). The study of SCD as a consistently progressive ED reveals the mechanisms of SCD formation, its prognosis and prevention.

AIM OF STUDY To determine the dynamics of ED progression under the influence of each predictor in the chain of events of the continuum of SCD using the example of a group of initially healthy 7,959 male workers of locomotive crews of the Transbaikal Railway aged 18–66 years.

MATERIAL AND METHODS Based on the data of a 6-year observation of a natural group of 7,959 men, predictors of microalbuminuria (MAU), creatininemia (CR), reduced glomerular filtration rate (rGFR), retinopathy (RP), and SCD were determined for 22 positions. A 2×2 table, survival analysis, and multivariate analysis were used, and the relative risk (RR) of RF was estimated, which made it possible to construct a chronic kidney disease (CKD) continuum from the prepared symptomatic blocks: MAU, RP, CR, rGFR using the synthesis method, to which the rGFR 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 adding predictors to the SCD continuum were determined. The Kaplan–Meier (K–M) curves determined the time of SCD, stages of ED, and the effect of damage to RF.

RESULTS The formation of SCD can occur from RFs from any point of the SCD continuum and depends on their set, proximity of the RF to the outcome, its impact and (or) interaction with other predictors. The most dangerous RF of SCD is excessive alcohol consumption (EAC), causing damage to the heart and (or) kidneys, forming a dysfunctional circle of re-entry SCD, forming cardiorenal syndrome (CRS) with the magnitude of damage to tissues of target organs in a sequential chain of SCD events: EAC→2,63%MAU15,24%↔100%RP58,12%↔27,10%CR100%↔100%rGFR27,36%↔3,31%SCD47,64%←EAC. All other risk factors for SCD and CKD also worsen the condition and bring the SCD closer.

CONCLUSION Further study of the continuum of sudden cardiac death is needed to determine whether cardiac or renal involvement is primary.

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