17 May 2021
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Sudden death after 40

Dr Ross Walker
23 July 2013

By Ross Walker

The sudden unexpected death recently of James Gandolfini, the Soprano star, raises the vital question – could his and all other sudden cardiac deaths that occur be prevented?

The answer to this straight forward question is, the vast majority of these deaths (but not all) are completely preventable if the initial precipitating causes are detected and treated early.

One of the major issues here are the underlying causes. Sudden death below the age of forty has a different set of causes to those seen in older people. I will focus in this blog on sudden death over the age of forty.

People above forty usually die as a consequence of having significant atherosclerosis which is the progressive build up of fat and other inflammatory tissue in the walls of arteries, typically the coronary arteries in the heart. This is not a slow blockage but the sudden rupture of a fatty plaque leading to a clot over the rupture and the blockage of an artery.

The best way to detect early disease is to have a coronary calcium score which is a painless technique using a CT scanner. It does not involve dye or injections and it is basically an indirect measure of the amount of fat in the walls of the coronary arteries. The higher the calcium score, the greater the fat load. The calcium is not the problem but purely a mark of the amount of fat you have. A zero score implies a ten year risk for a heart attack of only 1 per cent whereas a score above 400 implies a very significant atherosclerotic load. It is my suggestion that all males at age fifty and all females at age sixty, have a coronary calcium score as a routine screen for cardiac risk but if you have a more significant problem with cholesterol, blood pressure, cigarette smoking, diabetes or a family history of a relative who relatively suffered cardiac disease or stroke below the age of sixty, then you should have this test earlier. 

Once you have established whether you are at low risk or high risk for a heart attack, the next important step is to bring in preventative strategies to ensure you remain healthy. If you are already at significant risk for a heart attack, i.e. a calcium score that places you in the top 25 per cent for your age, then you need an extensive cardiac work up to determine the potential underlying causes of your condition and then strategies to directly treat these causes. I will address all of these issues in future articles (blogs).

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