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The major risk markers for primary prevention include a family history of sudden cardiac death, left ventricular wall thickness of at least 30 mm, left ventricular apical aneurysm, unexplained syncope, multiple prolonged episodes of nonsustained ventricular tachycardia, extensive late gadolinium enhancement, and left ventricular ejection fraction (LVEF) of less than 50%

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It is a temporal pattern that supports a direct neurological effect rather than an indirect one mediated through body weight changes