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Published in: Journal of General Internal Medicine 2/2020

01-02-2020 | Obesity | Original Research

Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death

Authors: Golsa Joodi, MD, MPH, Joan A. Maradey, MD, Brittany Bogle, PhD, MPH, Mojtaba Mirzaei, MD, MPH, Murrium I. Sadaf, MD, Irion Pursell, RN, BSN, Cory Henderson, MD, John Paul Mounsey, BM BCh, PhD, Ross J. Simpson Jr, MD, PhD

Published in: Journal of General Internal Medicine | Issue 2/2020

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Abstract

Background

Sudden death is a public health problem with major impact on society. Coronary artery disease (CAD) is believed to underlie 60–80% of these deaths. While deaths from CAD have decreased in the recent decades, sudden death rates remain unacceptably high.

Objective

We aimed to assess the prevalence of CAD and its risk factors among 18–64-year-old adults in a population-based case registry of sudden deaths and compare them to a living population from the same geographical area.

Design

From 2013 to 2015, all sudden deaths among 18–64-year-old adults in Wake County, NC, were identified (n = 371). A comparison group was formed by randomly selecting individuals from an electronic health record repository of a major healthcare system in the area (N = 4218).

Main Measures

Prevalence of CAD and its risk factors among cases of sudden death and living population across sex and age groups. Odds of sudden death associated with atherosclerotic risk factors and comorbidities.

Key Results

CAD was present in 14.8% of sudden death cases. Among sudden death victims, most risk factors and comorbidities were more common in the older age group, except for obesity which was more common in younger cases, and diabetes which was equally prevalent in younger and older cases. Compared to living population, sudden death cases had higher prevalence of atherosclerotic risk factors across all gender and age groups. Sudden death cases had a numerically higher number of risk factors compared to living population, regardless of age group or presence of CAD.

Conclusions

Coronary artery disease is not common among sudden death cases, but risk factors and comorbidities are prevalent. Our findings support the changing etiology of sudden death. In the absence of clinically diagnosed CAD, use of novel imaging modalities and biomarkers may identify high-risk individuals and lead to prevention of sudden death.
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Literature
1.
go back to reference Kong MH, Fonarow GC, Peterson ED, et al. Systematic review of the incidence of sudden cardiac death in the United States. J Am Coll Cardiol. 2011;57:794–801.CrossRefPubMedPubMedCentral Kong MH, Fonarow GC, Peterson ED, et al. Systematic review of the incidence of sudden cardiac death in the United States. J Am Coll Cardiol. 2011;57:794–801.CrossRefPubMedPubMedCentral
2.
go back to reference Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133:e38–e360.PubMed Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133:e38–e360.PubMed
3.
go back to reference Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63–81.CrossRefPubMed Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63–81.CrossRefPubMed
6.
go back to reference Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356:2388–98.CrossRefPubMed Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356:2388–98.CrossRefPubMed
8.
go back to reference Junttila MJ, Hookana E, Kaikkonen KS, Kortelainen ML, Myerburg RJ, Huikuri HV. Temporal trends in the clinical and pathological characteristics of victims of sudden cardiac death in the absence of previously identified heart disease. Circ Arrhythm Electrophysiol. 2016;9(6):e003723. Junttila MJ, Hookana E, Kaikkonen KS, Kortelainen ML, Myerburg RJ, Huikuri HV. Temporal trends in the clinical and pathological characteristics of victims of sudden cardiac death in the absence of previously identified heart disease. Circ Arrhythm Electrophysiol. 2016;9(6):e003723.
9.
go back to reference Mounsey LA, Lin FC, Pursell I, et al. Relation of Household Income to Incidence of Sudden Unexpected Death in Wake County, North Carolina. Am J Cardiol. 2017;119:1030–1035.CrossRefPubMed Mounsey LA, Lin FC, Pursell I, et al. Relation of Household Income to Incidence of Sudden Unexpected Death in Wake County, North Carolina. Am J Cardiol. 2017;119:1030–1035.CrossRefPubMed
11.
go back to reference Gorgels APM, Gijsbers C, de Vreede-Swagemakers J, Lousberg A, Wellens HJJ. Out-of-hospital cardiac arrest-the relevance of heart failure. The Maastricht Circulatory Arrest Registry. Eur Heart J. 2003;24:1204–1209.CrossRefPubMed Gorgels APM, Gijsbers C, de Vreede-Swagemakers J, Lousberg A, Wellens HJJ. Out-of-hospital cardiac arrest-the relevance of heart failure. The Maastricht Circulatory Arrest Registry. Eur Heart J. 2003;24:1204–1209.CrossRefPubMed
12.
go back to reference Noheria A, Teodorescu C, Uy-Evanado A, et al. Distinctive profile of sudden cardiac arrest in middle-aged vs. older adults: a community-based study. Int J Cardiol. 2013;168:3495–9.CrossRefPubMedPubMedCentral Noheria A, Teodorescu C, Uy-Evanado A, et al. Distinctive profile of sudden cardiac arrest in middle-aged vs. older adults: a community-based study. Int J Cardiol. 2013;168:3495–9.CrossRefPubMedPubMedCentral
13.
go back to reference Lacourciere Y, Cote C, Lefebvre J, Dumont M. Noninvasive detection of silent coronary artery disease in patients with essential hypertension, alone or associated with type 2 diabetes mellitus, using dipyridamole stress 99mtechnetium-sestamibi myocardial perfusion imaging. Can J Cardiol. 2006;22 Suppl A:16A–21A.PubMed Lacourciere Y, Cote C, Lefebvre J, Dumont M. Noninvasive detection of silent coronary artery disease in patients with essential hypertension, alone or associated with type 2 diabetes mellitus, using dipyridamole stress 99mtechnetium-sestamibi myocardial perfusion imaging. Can J Cardiol. 2006;22 Suppl A:16A–21A.PubMed
14.
go back to reference O'Neal WT, Shah AJ, Efird JT, Rautaharju PM, Soliman EZ. Subclinical Myocardial Injury Identified by Cardiac Infarction/Injury Score and the Risk of Mortality in Men and Women Free of Cardiovascular Disease. Am J Cardiol. 2014;114:1018–1023.CrossRefPubMedPubMedCentral O'Neal WT, Shah AJ, Efird JT, Rautaharju PM, Soliman EZ. Subclinical Myocardial Injury Identified by Cardiac Infarction/Injury Score and the Risk of Mortality in Men and Women Free of Cardiovascular Disease. Am J Cardiol. 2014;114:1018–1023.CrossRefPubMedPubMedCentral
15.
go back to reference Konety SH, Koene RJ, Norby FL, et al. Echocardiographic Predictors of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study. Circ Cardiovasc Imaging. 2016;9(8):e004431. Konety SH, Koene RJ, Norby FL, et al. Echocardiographic Predictors of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study. Circ Cardiovasc Imaging. 2016;9(8):e004431.
16.
go back to reference Niemeijer MN, Leening MJG, van den Berg ME, et al. Subclinical Abnormalities in Echocardiographic Parameters and Risk of Sudden Cardiac Death in a General Population: The Rotterdam Study. J Card Fail. 2016;22:17–23.CrossRefPubMed Niemeijer MN, Leening MJG, van den Berg ME, et al. Subclinical Abnormalities in Echocardiographic Parameters and Risk of Sudden Cardiac Death in a General Population: The Rotterdam Study. J Card Fail. 2016;22:17–23.CrossRefPubMed
17.
go back to reference Siscovick DS, Raghunathan TE, Rautaharju P, Psaty BM, Cobb LA, Wagner EH. Clinically Silent Electrocardiographic Abnormalities and Risk of Primary Cardiac Arrest Among Hypertensive Patients. Circulation. 1996;94:1329–1333.CrossRefPubMed Siscovick DS, Raghunathan TE, Rautaharju P, Psaty BM, Cobb LA, Wagner EH. Clinically Silent Electrocardiographic Abnormalities and Risk of Primary Cardiac Arrest Among Hypertensive Patients. Circulation. 1996;94:1329–1333.CrossRefPubMed
18.
go back to reference Adabag AS, Peterson G, Apple FS, Titus J, King R, Luepker RV. Etiology of sudden death in the community: results of anatomical, metabolic, and genetic evaluation. Am Heart J. 2010;159:33–9.CrossRefPubMedPubMedCentral Adabag AS, Peterson G, Apple FS, Titus J, King R, Luepker RV. Etiology of sudden death in the community: results of anatomical, metabolic, and genetic evaluation. Am Heart J. 2010;159:33–9.CrossRefPubMedPubMedCentral
19.
go back to reference Alpert MA, Terry BE, Mulekar M, et al. Cardiac Morphology and Left Ventricular Function in Normotensive Morbidly Obese Patients With and Without Congestive Heart Failure, and Effect of Weight Loss. Am J Cardiol. 1997;80:736–740.CrossRefPubMed Alpert MA, Terry BE, Mulekar M, et al. Cardiac Morphology and Left Ventricular Function in Normotensive Morbidly Obese Patients With and Without Congestive Heart Failure, and Effect of Weight Loss. Am J Cardiol. 1997;80:736–740.CrossRefPubMed
20.
go back to reference Ishizu T, Seo Y, Kameda Y, et al. Left Ventricular Strain and Transmural Distribution of Structural Remodeling in Hypertensive Heart Disease. Hypertension. 2014;63(3):500–6. Ishizu T, Seo Y, Kameda Y, et al. Left Ventricular Strain and Transmural Distribution of Structural Remodeling in Hypertensive Heart Disease. Hypertension. 2014;63(3):500–6.
21.
go back to reference Adabag AS, Maron BJ, Appelbaum E, et al. Occurrence and Frequency of Arrhythmias in Hypertrophic Cardiomyopathy in Relation to Delayed Enhancement on Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2008;51:1369–1374.CrossRefPubMed Adabag AS, Maron BJ, Appelbaum E, et al. Occurrence and Frequency of Arrhythmias in Hypertrophic Cardiomyopathy in Relation to Delayed Enhancement on Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2008;51:1369–1374.CrossRefPubMed
22.
go back to reference Shenasa M, Shenasa H. Hypertension, left ventricular hypertrophy, and sudden cardiac death. Int J Cardiol. 2017;237:60–63.CrossRefPubMed Shenasa M, Shenasa H. Hypertension, left ventricular hypertrophy, and sudden cardiac death. Int J Cardiol. 2017;237:60–63.CrossRefPubMed
23.
go back to reference Maheshwari A, Norby FL, Soliman EZ, et al. Low Heart Rate Variability in a 2-Minute Electrocardiogram Recording Is Associated with an Increased Risk of Sudden Cardiac Death in the General Population: The Atherosclerosis Risk in Communities Study. PLoS One. 2016;11:e0161648.CrossRefPubMedPubMedCentral Maheshwari A, Norby FL, Soliman EZ, et al. Low Heart Rate Variability in a 2-Minute Electrocardiogram Recording Is Associated with an Increased Risk of Sudden Cardiac Death in the General Population: The Atherosclerosis Risk in Communities Study. PLoS One. 2016;11:e0161648.CrossRefPubMedPubMedCentral
24.
go back to reference Rea TD, Pearce RM, Raghunathan TE, et al. Incidence of Out-of-Hospital cardiac arrest. Am J Cardiol. 2004;93:1455–1460.CrossRefPubMed Rea TD, Pearce RM, Raghunathan TE, et al. Incidence of Out-of-Hospital cardiac arrest. Am J Cardiol. 2004;93:1455–1460.CrossRefPubMed
25.
go back to reference Fernández-Friera L, Ibáñez B, Fuster V. Imaging Subclinical Atherosclerosis: Is It Ready for Prime Time? A Review. J Cardiovasc Transl Res. 2014;7:623–634.CrossRefPubMed Fernández-Friera L, Ibáñez B, Fuster V. Imaging Subclinical Atherosclerosis: Is It Ready for Prime Time? A Review. J Cardiovasc Transl Res. 2014;7:623–634.CrossRefPubMed
27.
go back to reference Gao P, Yee R, Gula L, et al. Prediction of arrhythmic events in ischemic and dilated cardiomyopathy patients referred for implantable cardiac defibrillator: evaluation of multiple scar quantification measures for late gadolinium enhancement magnetic resonance imaging. Circ Cardiovasc Imaging. 2012;5:448–56.CrossRefPubMed Gao P, Yee R, Gula L, et al. Prediction of arrhythmic events in ischemic and dilated cardiomyopathy patients referred for implantable cardiac defibrillator: evaluation of multiple scar quantification measures for late gadolinium enhancement magnetic resonance imaging. Circ Cardiovasc Imaging. 2012;5:448–56.CrossRefPubMed
28.
go back to reference Macatangay C, Viles-Gonzalez JF, Goldberger JJ. Role of Cardiac Imaging in Evaluating Risk for Sudden Cardiac Death. Card Electrophysiol Clin. 2017;9:639–650.CrossRefPubMed Macatangay C, Viles-Gonzalez JF, Goldberger JJ. Role of Cardiac Imaging in Evaluating Risk for Sudden Cardiac Death. Card Electrophysiol Clin. 2017;9:639–650.CrossRefPubMed
29.
go back to reference Nazarian S, Bluemke DA, Lardo AC, et al. Magnetic resonance assessment of the substrate for inducible ventricular tachycardia in nonischemic cardiomyopathy. Circulation. 2005;112:2821–5.CrossRefPubMedPubMedCentral Nazarian S, Bluemke DA, Lardo AC, et al. Magnetic resonance assessment of the substrate for inducible ventricular tachycardia in nonischemic cardiomyopathy. Circulation. 2005;112:2821–5.CrossRefPubMedPubMedCentral
30.
go back to reference Lindholm D, Lindbäck J, Armstrong PW, et al. Biomarker-Based Risk Model to Predict Cardiovascular Mortality in Patients With Stable Coronary Disease. J Am Coll Cardiol. 2017;70:813–826.CrossRefPubMed Lindholm D, Lindbäck J, Armstrong PW, et al. Biomarker-Based Risk Model to Predict Cardiovascular Mortality in Patients With Stable Coronary Disease. J Am Coll Cardiol. 2017;70:813–826.CrossRefPubMed
31.
go back to reference McEvoy JW, Chen Y, Ndumele CE, et al. Six-year change in high-sensitivity cardiac troponin t and risk of subsequent coronary heart disease, heart failure, and death. JAMA Cardiol. 2016;1:519–528.CrossRefPubMedPubMedCentral McEvoy JW, Chen Y, Ndumele CE, et al. Six-year change in high-sensitivity cardiac troponin t and risk of subsequent coronary heart disease, heart failure, and death. JAMA Cardiol. 2016;1:519–528.CrossRefPubMedPubMedCentral
Metadata
Title
Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death
Authors
Golsa Joodi, MD, MPH
Joan A. Maradey, MD
Brittany Bogle, PhD, MPH
Mojtaba Mirzaei, MD, MPH
Murrium I. Sadaf, MD
Irion Pursell, RN, BSN
Cory Henderson, MD
John Paul Mounsey, BM BCh, PhD
Ross J. Simpson Jr, MD, PhD
Publication date
01-02-2020
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 2/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-019-05486-6

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