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A search was made for predictors of sudden cardiac death (SCD) among 197 men, age 40 to 79, who had multiphasic health checkups and experienced SCD 2 days to 5 1/2 years later (mean 18.1 months). Two age-sex-race-matched control groups, one matched and one unmatched for standard coronary risk factors, have been compared to the cases. In this ambulatory population, SCD occurred largely in persons with prior diagnosed heart disease. Standard coronary risk factors were confirmed as predictors of SCD. Predictors among other laboratory and quantitative tests include chylous serum, uric acid, hemoglobin, leukocyte count, pulse rate, diminished lung volumes, and hearing loss. Some of these had predictive value independent of standard risk factors. Pain tolerance was not related to SCD or to death in, versus out of hospital. Most of these predictors were not related to terminal symptom duration; this suggests a relationship more to the underlying atherosclerotic process than to the terminal fatal mechanism.

Studying coronary risk factors, this article concludes that: regular use of alcohol may protect against major coronary events; regular use of three or more drinks daily is a probable risk factor for hypertension; the relations of alcohol use to coronary disease, hypertension, and cardiomyopathy are disparate.

In a serach for risk factors for myocardial infarction and sudden cardiac death, the mean total vital capacity as measured at multiphasic health checkups was lower in persons who later had a first myocardial infarction than in risk-factor-matched controls (3.17 vs. 3.29 liters, 395 pairs, P less than 0.05) and non-risk-factor-matched controls (3.16 vs. 3.41 liters, 401 pairs, P less than 0.001). Findings were little affected by age and height adjustment and were similar for sudden cardiac death. The first-second vital capacity was also inversely related to later development of these conditions, but the ratio of that measurement to total vital capacity was not. Heavy smoking, productive cough, exertional dyspnea and cardiac enlargement were associated with diminished total capacity. However, exclusion of subjects with these findings did not reduce the predictive value of total vital capacity. Diminished vital capacity deserves continued attention as a possible coronary risk factor. Its relation to subsequent coronary events is not well explained.