Zhang Xuefeng, a prominent Chinese postgraduate entrance examination tutor known for his highenergy lectures and motivational style, died of sudden cardiac arrest on Tuesday after collapsing while running in Suzhou, Jiangsu province. He was 41.

News of Zhang's death moved quickly across Chinese social media, shocking former students and colleagues while renewing public concern over the rising risk of sudden cardiac death among young and middle-aged adults.

According to an epidemiological survey by the National Center for Cardiovascular Diseases, the incidence of sudden cardiac death in China is 41.84 cases per 100,000 people. This estimate suggests nearly 544,000 people in China experience sudden cardiac death annually — an average of 1,500 per day — with an out-of-hospital survival rate of less than 1 percent.

Zhang had reportedly logged 72 kilometers of running this month. His death highlights how even physically active individuals can remain vulnerable to hidden cardiovascular risks.

"Heart disease is no longer just an elderly person's problem," said Zhou Dongchen, a physician at the First Affiliated Hospital of Zhejiang University School of Medicine. "We are seeing a clear shift toward younger age groups, particularly middle-aged men, who face elevated risks due to chronic overwork, sleep deprivation and emotional stress."

A 2020 study published in the Chinese Journal of Emergency Medicine analyzed 5,516 autopsy-confirmed cases across 28 provinces and found that people aged 31 to 63 accounted for 57.76 percent of sudden cardiac deaths.

Doctors say the body often sends warning signals before a fatal event. A study in the Annals of Internal Medicine found that more than half of patients experience symptoms within the 24 hours preceding the event, such as chest pain, palpitations, extreme fatigue, or dizziness.

"These symptoms are often the body's last warning," said Zhang Ling, an internist at the China-Japan Friendship Hospital in Beijing."But many people dismiss them as simple fatigue."

Zhang noted that lifestyle changes linked to China's rapid economic development — including diets high in processed foods, long working hours, and chronic sleep deprivation — have increased cardiovascular strain. She cautioned that intense exercise can be dangerous when the body is already severely fatigued.

"When people are overly tired, intense exercise stimulates the sympathetic nervous system and raises blood pressure," she said. "This can destabilize arterial plaques, leading to cardiovascular emergencies."

Specialists recommend that those experiencing unusual fatigue or breathlessness during exercise seek medical attention immediately. Beyond routine electrocardiograms, doctors suggest echocardiography or 24-hour Holter monitoring to detect hidden issues.

Because over 90 percent of sudden cardiac deaths occur outside of hospitals, Zhang Ling emphasized the necessity of emergency preparedness.

"In cardiac arrest, the first few minutes are critical," she said. "Immediate CPR and the use of an automated external defibrillator can make the difference between life and death."

weiwangyu@chinadaily.com.cn