Risk-factor Changes Could Prevent the Majority of Sudden Cardiac Arrests

A new study identifying 56 non-clinical risk factors associated with sudden cardiac arrest (SCA), spanning lifestyle, physical measures, psychosocial factors, socioeconomic status, and the local environment, offers compelling evidence that improving these unfavorable profiles could prevent up to 63% of SCA cases. The article opens in new tab/window appearing in the Canadian Journal of Cardiology opens in new tab/window, published by Elsevier, provides new insights into how lifestyle and environmental factors can contribute to SCA prevention.

SCA is a global public health challenge with profound physical and psychosocial consequences for the individuals affected, along with far-reaching impacts on families, friends, and entire communities. Its high fatality rate and unpredictability make it a leading cause of death worldwide. In Canada, an estimated 60,000 SCAs occur annually. A reliable and practical approach to mitigate the burden of SCA entails investigating the long-term, modifiable risk factors and subsequently formulating preventive measures. However, significant knowledge gaps regarding SCA prevention persist.

Lead investigator and first author of the article "Modifiable Risk Factors and Attributable Burden of Cardiac Arrest: An Exposome-wide and Mendelian Randomization Analysis opens in new tab/window" Huihuan Luo, PhD, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China, explains, "All previous studies investigating the risk factors of SCA were hypothesis-driven and focused on a limited number of candidate exposure factors grounded in prior knowledge or theoretical frameworks. We conducted an exposome-wide association study, which examines the relationship between a wide range of environmental exposures and health outcomes using UK Biobank data, followed by Mendelian randomization to assess causal relationships. The study found significant associations between various modifiable factors and SCA, with lifestyle changes being the most impactful in preventing cases."

Eliminating the worst 1/3 of all risk domains (conservative elimination), 40% of SCA cases could be prevented according to the study, rising to 63% SCA prevention if the worst 2/3 of all risk factors were eliminated (thorough elimination). Lifestyle habits appeared to contribute the most to SCA prevention, accounting for 13% and 18% of SCA cases under conservative and thorough elimination, respectively.

Co-investigator Renjie Chen, PhD, Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China, points out, "To our knowledge, this is the first study that comprehensively investigated the associations between non-clinical modifiable risk factors and SCA incidence. We were surprised by the large proportion (40%–63%) of SCA cases that could be prevented by improving unfavorable profiles."

Researchers found that factors such as higher consumption of champagne/white wine and increased fruit intake, along with maintaining a positive mood, weight management, blood pressure control, and improved education, may serve as important protective factors.

The authors of the accompanying editorial "Transitioning from Reaction to Prevention in Sudden Cardiac Arrest: Causal Clues and Caveats from Mendelian Randomization Studies opens in new tab/window" Nicholas Grubic, MSc, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, ON, Canada, and Dakota Gustafson, PhD, Department of Emergency Medicine and Department of Epidemiology, Faculty of Medicine, Queen’s University, Kingston, ON, Canada, say, "One of the study’s most intriguing findings is the cardioprotective effect associated with champagne and white wine consumption, questioning long-held assumptions about the specificity of red wine's cardioprotective properties. Research on the underlying mechanisms remains unclear, but these findings reinforce the idea that the benefits of moderate alcohol consumption may be more complex than previously assumed."

Surprisingly, computer use showed an inverse relationship with SCA risk, seemingly contradicting sedentary behavior risks. Dr. Luo explains, "While our initial analysis showed that correlation, we strongly suspect this reflects underlying socioeconomic or occupational differences between groups, not a direct protective effect from screen time. This is a common challenge in observational studies. By using advanced methods like Mendelian Randomization, we were able to dig deeper and filter out some of that 'noise.' The results from those more rigorous analyses didn't show the same protective link, which strengthens our confidence in identifying the other, more clearly modifiable factors as the key targets for prevention."

Mr. Grubic and Dr. Gustafson conclude, "To achieve dramatic reductions in the immense burden SCA places on the health system, this narrative must extend beyond acute intervention to a broader, population-wide strategy that prioritizes primary prevention. While shifting from responding to SCA to actively preventing its occurrence may seem straightforward, it is far more complex in practice. The multifactorial nature of these events – often influenced by a combination of genetic predispositions, underlying cardiovascular conditions, environmental triggers, and lifestyle factors – poses significant challenges for healthcare professionals and policymakers. Identifying modifiable factors linked to SCA is crucial for informing the development of high-quality public health messaging and interventions, especially in resource-limited environments."

Notes for editors

The article is “Modifiable Risk Factors and Attributable Burden of Cardiac Arrest: An Exposome-wide and Mendelian Randomization Analysis,” by Huihuan Luo, PhD, Qingli Zhang, PhD, Lu Zhou, MS, Anni Li, BA, Haidong Kan, PhD, and Renjie Chen, PhD (https://doi.org/10.1016/j.cjca.2025.02.027 opens in new tab/window).

The article is openly available for 30 days at https://onlinecjc.ca/article/S0828-282X(25)00171-0/fulltext opens in new tab/window.

Journalists wishing to speak to the authors should contact Huihuan Luo, PhD, at [email protected] opens in new tab/window.

This work was supported by the National Key Research and Development Program (2022YFC3702701), the National Natural Science Foundation of China (92043301), and the Shanghai Committee of Science and Technology (21TQ015).

The editorial commentary is "Moving From Reaction to Prevention in Sudden Cardiac Arrest: Causal Clues and Caveats from Mendelian Randomisation Studies," by Nicholas Grubic, MSc, and Dakota Gustafson, PhD (https://doi.org/10.1016/j.cjca.2025.03.019 opens in new tab/window).

The article is openly available for 30 days at https://onlinecjc.ca/article/S0828-282X(25)00203-X/fulltext opens in new tab/window.

Journalists wishing to speak to the authors should contact Nicholas Grubic, MSc, at [email protected] opens in new tab/window.

Both articles appear online in the Canadian Journal of Cardiology, published by Elsevier.

Full text of the articles is also available to credentialed journalists upon request. Contact Astrid Engelen at +31 6 14395474 or [email protected] opens in new tab/window to request a PDF of the article or more information.

About the Canadian Journal of Cardiology

The Canadian Journal of Cardiology opens in new tab/window is the official journal of the Canadian Cardiovascular Society opens in new tab/window. It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as a major venue for the results of Canadian cardiovascular research and Society guidelines. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, review articles, case reports, and papers on health outcomes, policy research, ethics, medical history, and political issues affecting practice. www.onlinecjc.ca opens in new tab/window

About the Editor-in-Chief

Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About the Canadian Cardiovascular Society (CCS)

The CCS opens in new tab/window is the national voice for cardiovascular clinicians and scientists, representing more than 2,300 cardiologists, cardiac surgeons and other heart health specialists across Canada. We advance heart health for all by setting standards for excellence in heart health and care, building the knowledge and expertise of the heart team, and influencing policy and advocating for the heart health of all Canadians. For further information on the CCS visit www.ccs.ca/en opens in new tab/window.

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