December 3, 2002

A Message About Sudden Cardiac Death

The Hopkins community was shocked and saddened by the recent sudden cardiac deaths of three faculty members in the prime of their careers. Dr. Jeffrey Williams, a neurosurgeon and oncologist and Director of Stereotactic Surgery, was exercising at the Cooley Center when he experienced a cardiac arrest. Dr. David Nagey, an obstetrician/gynecologist and Director of Perinatology at Hopkins, suffered a cardiac arrest while running a 5-K fund raising race for his son’s school to raise money for education. Most recently, Dr. Frederick “Rick” Montz, Professor of Gynecology and an expert in gynecologic malignancies, collapsed and died while jogging.

Unfortunately, sudden cardiac death is not an uncommon occurrence; it accounts for more than 250,000 deaths each year in this country. We would like to remind our colleagues of the importance of screening for cardiovascular risk factors and the significant impact that successful risk factor modification can have on one’s cardiovascular health. Much has been learned in the past decade about cardiovascular disease prevention. Listed below are some of the important issues that you may want to discuss with your own health care provider when you are trying to lower your risk of cardiovascular disease. We call it the ABC’s of Prevention.

Aspirin: Discuss whether the benefits of taking a low dose of an antiplatelet agent such as aspirin outweigh the risks of bruising or bleeding?

Blood Pressure: A normal blood pressure is < 130 /85 mm Hg. Hypertension is classified as > 140/90 mm Hg. If your blood pressure is not at goal, discuss the need for further lifestyle improvements such as dietary changes and increased physical activity as well as medication to control your blood pressure.

Cholesterol: Normal total cholesterol values are < 200 mg/dl and normal triglycerides (blood fats) are < 150 mg/dl. A normal HDL-cholesterol (good or protective cholesterol) for a man is > 40 mg/dl and for a woman it is > 50 mg/dl. A normal LDL-cholesterol (bad cholesterol) is < 130 mg/dl and an optimal value is < 100 mg/dl.

If you have diabetes or known atherosclerotic vascular disease (hardening of the arteries), national guidelines recommend achieving an LDL-C < 100 mg/dl as well as controlling your triglycerides. If your cholesterol values are not at goal, discuss the need for lifestyle improvements and possibly medication to improve your cholesterol profile.

Cigarettes: If you smoke, work with your health care provider to quit as soon as possible. Discuss the use of nicotine patches, gum, or inhalers as well as prescription medication to assist you.

Diet and weight: Discuss a diet and exercise program that will assist you in achieving and maintaining a desirable weight, blood pressure, blood glucose, and cholesterol levels.

Diabetes/blood sugar control: Diabetes is an important risk factor for heart disease and stroke. A fasting blood sugar > 125 mg/dl on 2 consecutive occasions is one way of diagnosing diabetes. Fasting blood sugars from 110-125 mg/dl are considered high and are part of the metabolic syndrome or pre-diabetic state. Discuss a plan to evaluate your blood sugar control.

Diagnostic studies: If you are planning to begin a vigorous exercise program or if you have a family history of heart disease or if you have a major risk factor for heart disease, discuss whether an exercise stress test (to assess exercise tolerance and look for the presence of decreased blood flow to the heart in the absence or presence of chest pain), ultrafast CT scan of the heart (to assess the amount of advanced plaque in the heart arteries) or blood tests for novel risk factors (such as hs-C-reactive protein (CRP)) may be useful in your management.

Individuals with calcium scores > 75th % of age and gender matched peers and/or elevated CRP values or may benefit from more intensive and comprehensive risk improvements.

Exercise: A good exercise program consists of aerobic activity, strength training and flexibility exercises. It is recommended that persons participate in brisk walking or similar activities for 30 minutes a day most days of the week. Before you begin a vigorous exercise program, talk to your health care provider about whether an exercise stress test may be useful.

Wendy S. Post, MD, MS
Assistant Professor of Medicine

Roger S. Blumenthal, MD
Associate Professor of Medicine

M. Dominique Ashen, NP, PhD
Assistant Professor, School of Nursing