Prevent Early, Prevent Sudden Death

Editor's Note :

Sudden deaths in the headlines—and closer to home—are a wake-up call. Though sudden death may seem to strike without warning, many cases show clear risks and warning signs.

In a special four-part series, Cultural Express features Dr. Wen-Ta Chiu—former Taiwan Minister of Health and Welfare and current Co-CEO of AHMC Healthcare—sharing expert insights on the risk factors behind sudden death and the keys to prevention.

---

Sudden death can be divided into "traumatic" (accidents, homicide, suicide, etc.) and "non-traumatic" categories, each accounting for roughly half of all cases globally. 

Worldwide, traumatic sudden death (approximately 8%) exceeds non-traumatic (approximately 6%), though the United States shows the reverse — non-traumatic (8–10%) outpaces traumatic (6–7%). 

Today we focus on non-traumatic sudden death, because it is what most commonly affects us and our families. 

Research shows that over 70% of non-traumatic sudden deaths are linked to controllable chronic conditions — meaning many of these tragedies can be prevented.

In Chinese culture, we value "taking care of your body." Yet few people truly practice prevention. Protecting life is not solely the hospital's responsibility — it is every family's.

I. The Five Leading Causes of Non-Traumatic Sudden Death

Among adults, sudden death primarily stems from five categories (ranked by frequency) :

Sudden Cardiac Death (approx. 65–75%) : The most common cause, including coronary artery occlusion (myocardial infarction), life-threatening arrhythmia, and cardiomyopathy — mostly linked to hypertension, diabetes, high cholesterol, and atherosclerosis.

1. 
   
2. Cerebrovascular Rupture (approx. 10–15%) : Such as massive cerebral hemorrhage or aneurysm rupture, often associated with poorly controlled hypertension and atherosclerosis, etc.
   
   
3. Pulmonary Embolism (approx. 5–10%) : A blood clot blocking the pulmonary artery, potentially causing sudden shock. Common after prolonged sitting, long-haul flights, or surgery.
   

⬆Deep vein thrombosis (DVT) traveling to the left lung, causing pulmonary embolism

4. Aortic Dissection (approx. 3–5%) : Hardened vessel walls develop an inner-layer tear; blood enters and separates the layers, causing sudden cardiac arrest — closely linked to long-term hypertension.

5. Other Acute Conditions (approx. 3–5%) : Including severe allergic reactions, drug overdose, and electrolyte imbalances.

⬆Multi-system dysfunction leading to electrolyte imbalances (Na⁺, K⁺, Ca²⁺, Mg²⁺)

II. Most People Had Warning Signs

Large-scale studies have found :

• Approximately 70–80% of patients experienced symptoms within the month before the event.
• Approximately 50% had noticeable discomfort within the 24 hours prior.

Common symptoms include :

• Chest tightness or chest pain (40–50%)
• Difficulty breathing (30–40%)
• Palpitations (20–30%)
• Dizziness or fainting (10–20%)
• Nausea and cold sweats

Notably, women often present with atypical symptoms — such as upper abdominal discomfort, back pain, or unusual fatigue — making them more likely to delay seeking care.

III. Short-Term Prevention : Critical Actions When Symptoms Appear

Don't wait. If chest pain lasts more than 5 minutes, especially combined with cold sweats, nausea, or difficulty breathing — call emergency services immediately.

U.S. data shows that out-of-hospital cardiac arrest survival rates are approximately 10%. If bystanders perform CPR immediately, survival rates can increase 2–3 times.

Learn CPR and how to use an AED. 

After collapse, the brain may begin to sustain damage within 4–6 minutes. Early CPR or defibrillation is often the difference between life and death. 

Regular CPR and AED training is strongly encouraged. AEDs provide clear audio instructions and can be effectively used even by non-medical personnel.

Know who is at higher risk. 

If you have heart disease, stroke, hypertension, diabetes, or high cholesterol — or a family history of these conditions, or a personal history of chest tightness, fainting, or seizures — carry this information clearly in your wallet or pocket.

IV. Long-Term Prevention : Three Steps to Reduce Risk by 70%

1. Control the "Three Highs": Hypertension doubles the risk of sudden death; diabetes increases it 2–4 times; every 38 mg/dL rise in LDL increases cardiovascular risk by approximately 20%. 

Keeping blood pressure below 130/80 mmHg is the most fundamental life-saving measure.

1. Exercise regularly : 150 minutes of moderate-intensity exercise per week can reduce cardiovascular mortality by 30–40%. 

Sitting for more than 8 hours per day increases risk by 20–30%. A 30-minute brisk walk daily is the most cost-effective investment in your health.

1. Manage sleep : Sleeping fewer than 6 hours per night long-term raises cardiovascular disease risk by 20–40%; when combined with sleep apnea, the risk of sudden death can more than double. 

Repeated nighttime oxygen deprivation activates the sympathetic nervous system, raising blood pressure, causing arrhythmia, and accelerating atherosclerosis. 

Research also finds that many cardiac sudden deaths occur in the early morning hours, closely tied to autonomic nervous system changes. 

Maintaining 7–8 hours of regular nightly sleep is an important foundation for stable heart rhythm and blood pressure.

1. Quit smoking and manage your weight : Quitting smoking can reduce cardiovascular risk by approximately 36–50%. Excessive waist circumference typically reflects excess visceral fat — a hidden but serious risk factor.

V. 10-Second Sudden Death Risk Self-Assessment

Based on evidence from the Framingham Heart Study, AHA cardiovascular risk research, and sudden cardiac death epidemiology — the vast majority of sudden deaths (approximately 80–90%) are cardiovascular-related. 

The following 10-second self-assessment is for reference only :

• Age ≥ 50
• Male
• Hypertension or currently taking blood pressure medication
• Diabetes or elevated blood sugar
• High cholesterol or currently taking lipid-lowering medication
• Smoking (current or within the past 10 years)
• Less than 150 minutes of exercise per week
• Large waist circumference (men ≥ 90 cm; women ≥ 80 cm)
• Average sleep less than 6 hours per night, or sleep apnea
• First-degree relative with sudden death or heart disease before age 50

Scoring : 0–1 = low risk; 2–3 = moderate risk; 4–5 = high risk; 6 or more — seek medical evaluation as soon as possible.

VI. Short-Term Response : The First Minute Is Critical

Three steps to protect your loved ones:

1. Call 119 immediately
2. Start chest compressions (CPR) right away
3. Use an AED as quickly as possible, if available

AEDs provide voice-guided instructions — anyone can operate them.

Overall out-of-hospital cardiac arrest survival is approximately 10%. With immediate CPR and AED use within minutes, survival rates can rise to 30–50% or higher (in public settings with rapid defibrillation). 

Chicago O'Hare Airport — one of the highest AED-density locations in the world — once achieved a survival rate of 64%.

Why is the AED so important ? The most common cause of sudden cardiac death is ventricular fibrillation (VF). In this state, the heart is not "stopped" — it is "quivering chaotically." 

The only effective treatment is electrical defibrillation. CPR maintains blood circulation, but only an AED can restore normal heart rhythm.

Time is life. Every 1-minute delay in defibrillation reduces survival chances by approximately 7–10%. After 10 minutes without a shock, survival is extremely unlikely.

CPR + AED = the best lifesaving combination.

VII. Call for Emergency Help Immediately If You Notice :

Chest pain lasting more than 5 minutes · Sudden difficulty breathing · Sudden loss of consciousness · Extremely irregular heartbeat · Weakness on one side of the body or difficulty speaking

Call for help immediately. It is always better to make one "unnecessary" call than to miss one life.

VIII. Protecting Life Is Both a Culture and a Responsibility

Chinese culture places deep value on family. In many cases, it is the wife or mother at home who truly drives health changes.

A timely reminder, a moment of companionship, one committed health check-up — these can change a family's future.

"There is a time to be born, and a time to die."

But medicine now tells us : seven out of ten sudden deaths can be delayed — or even avoided.

Protecting your loved ones starts today: check your blood pressure, take a walk together, learn basic first aid.【Health Column  | Sudden Death Prevention (1/4)】