Key stress triggers for sudden death.

AIM: The causes and triggers of SD as a whole are poorly understood. This study aimed to define the causes and triggers of SD systematically and provide guidance for preventive approaches.

METHODS

To account for potential geographical differences, we studied two independent populations. Population 1 included 2063 SD cases in Guangzhou. Population 2 included 1005 SD cases in multiple areas in China. SD cases were stratified to analyze key triggers in different age groups. A Student's t-test was used to analyze differences between continuous variables.

RESULTS

In Population 1, respiratory diseases were the leading cause of SD for children of ≤ 3 years, whereas cardiovascular diseases were the leading cause of SD for other age groups. Up to 4% of coronary artery disease related SD occurred to young adults under 30 years. 56% of SD cases were induced by at least one trigger. Pain appeared to be the leading trigger for SD (43%), followed by surgery (29%), fever (20%), emotion (14%), and alcohol drinking (8%). The top five triggers for SCD were pain, emotion, surgery, alcohol drinking, and fever. For sudden non-cardiac death (SNCD), pain remained the leading trigger, followed by surgery, fever, emotion and alcohol drinking. Similar findings were made in Population 2 and the combined populations.

CONCLUSIONS

Our study identified pain as the leading trigger of SD, followed by surgery, fever, emotion and alcohol drinking. The results may lead to targeted interventions such as pain control, fever suppression and alcohol abstinence for at-risk individuals to prevent SD.