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

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.

Keywords: SUDDEN; cardiovascular risk factor; coronary artery disease; sudden death.

Figure 1

Details of case ascertainment and identification of sudden deaths in Wake County, North Carolina. EMS, emergency medical services; SUDDEN, sudden unexpected death in North Carolina.

Figure 2

Average number of atherosclerotic cardiovascular disease risk factors in sudden death cases and living controls. Among all subjects (a), those with history of CAD (b), those without history of CAD (c). Atherosclerotic cardiovascular disease risk factors included in this comparison were smoking, obesity, hypertension, diabetes mellitus, dyslipidemia, and chronic renal disease. CAD, coronary artery disease.