Sudden cardiac death (SCD) is "a natural death due to cardiac causes, heralded by abrupt loss of consciousness within 1 hour of the onset of acute symptoms". Annual incidence is 0.36-1.28/1000 inhabitants. More than 1000 sudden deaths occur each day is in USA, and 100,000 people annually dead in the United Kingdom. Epidemiology differs greatly in 100-fold between young and old, and between developing and developed worlds. SCD is one of the leading causes of death and accounts for over 50% of the cardiac deaths. New data show that SCD is not nearly as sudden in most cases as the term may suggest. Warning symptoms that precede the sudden cardiac death are present for a surprisingly long time in many patients. Coronary artery disease (CAD) is the most common cause of death in the developed world. The major causes are inherited arrythmogenic right ventricular cardiomyopathy (ARVC), hypertrophic cardiomyopathy (HCM), anomalous coronary arteries and hereditary channelopathies (e.g., Long QT syndrome, LQTS). Prevalence is 3-4 fold higher in men, reflecting that of CAD. In adults, the incidence of CAD-related SCD varies with geography and age. The incidence of SCD increases with congestive heart failure (CHF), stroke, cancer and metabolic syndrome, particularly in the developed world. Coronary thrombi and plaque rupture or erosion are found in two thirds of SCD. In women over 50, rupture accounted for 80% of coronary thrombi. In Europe SCD accounts for 200,000 dead in 1 year. In FBiH rate of SCD fluctuates around 0.62/1000 inhabitants, in HNK it is 0.78/1000 and in Mostar 0.54/1000. A wide range of cardiac etiology and development of various management procedures in the primary and secondary preventive pharmacotherapy, device therapy, lifestyle changes and genetic profiling have had a major impact on the prediction and prevention of SCD. Improved resuscitation and defibrillation techniques together with advances in implantable pacemaker and defibrillator technology (AED) have all improved treatment outcome. Education of the Red Cross, Police, Army, Civic Protection members, public, patients and relatives to recognize and respond to symptoms of heart disease holds promise for reducing mortality attributed to sudden death. Developing a better understanding of the circumstances of sudden cardiac death and preventive measures and proper reactions to the impending events. Training in cardio-pulmonary resuscitation with public access defibrillation programs is necessary in fighting sudden death. Systematic screening of young athletes and implantation of implantable cardioverter defibrillators should prevent SCD. CONCLUSION: SCD remains one of the major public health problems in the world and is most commonly caused by CAD. Risk stratification is effective for groups, but difficult in case of individuals. There is a need for major improvements in prevention, risk protection, resuscitation and therapy.