Circulating nonesterified fatty acid level as a predictive risk factor forsudden death in the population

Background-In ischemic conditions, concentration of circulating nonesterifi ed fatty acids (NEFA) is increased and has a proarrhythmic effect that is r esponsible for ventricular tachyarrhythmias. In nonischemic patients, high NEFA plasma concentration has been shown to be associated with frequent pre mature ventricular complexes and increased familial risk of cardiovascular disease, but its relation to sudden death has not been studied. We assessed the role of circulating NEFA in sudden death in asymptomatic men in a long -term cohort study. Methods and Results-A total of 5250 men employed by the city of Paris, aged 42 to 53 in 1967 to 1972, free of known ischemic cardiac disease, and incl uded in the Paris Prospective Study I, completed a second annual examinatio n and had fasting plasma circulating NEFA measured. Each subject underwent a physical examination and ECG, provided blood for laboratory tests, and an swered questionnaires administered by trained interviewers. Vital status wa s obtained for each subject from specific inquiries until he retired; after retirement, it was obtained from death certificates. Body mass index, syst olic and diastolic blood pressures, tobacco consumption, parental history o f sudden death, fasting cholesterol level, and circulating NEFA concentrati on were independent factors associated with sudden death during follow up ( average, 22 years). When adjusted for confounding factors, circulating NEFA concentration remained an independent risk factor for sudden death (relati ve risk, 1.70; 95% confidence interval, 1.21 to 2.13) but not for fatal myo cardial infarction. Conclusions-Circulating NEFA concentration is an independent risk factor fo r sudden death in middle-aged men. Some form of primary prevention could be envisaged in subjects at high risk of sudden death.