Sudden Cardiac Death Risk Distribution in the United States Population (from NHANES, 2005 to 2012)

Sudden cardiac death (SCD) accounts for more than half of all deaths from cardiovascular disease and is the first manifestation of heart disease in 50% of these subjects. We aimed to describe the distribution of predicted SCD risk in the general US population using a recently developed risk score. We previously developed a population-based, 10-year risk score for SCD using data from the multiracial Atherosclerosis Risk in Communities cohort, validated in the Framingham Study. We now estimate 10-year predicted SCD risk in National Health and Nutrition Examination Survey participants (pooled from cycles in 2005 to 2012) and evaluate the clinical profile of participants in lower risk (0 to 80th percentile of risk) or high risk (81st to 100th percentile of risk) strata. A total of 10,811 participants were included; the mean age of participants was 48 years, and 50% were women. The average predicted 10-year risk of SCD was 3.6% in high-risk participants (81st to 100th percentile), and 0.37% in low-risk participants (0 to 80th percentile). High-risk participants were older, had higher blood pressure, total cholesterol and body mass index, lower high-density lipoprotein, and were more likely to be men, black, smokers, and diabetic. In US adults free of cardiovascular disease, the majority of SCD risk appears confined to 10% to 20% of the population. This risk score, comprised of readily available clinical variables, identifies a subset of individuals in the population who are at an appreciably higher risk of SCD. This enriched cohort represents candidates for additional nuanced and selective screening techniques to further quantify SCD risk.