cl.wedid.us index.php,Increase in sudden death from coronary artery disease in young adults

Coronary Artery Disease

Increase in sudden death from coronary artery disease in young adults

Dabit Arzamendi,MD,a Bego?a Benito,MD,a Helena Tizon-Marcos,MD,b Jose Flores,MD,a

Jean Fran?ois Tanguay,MD,a Hung Ly,MD,a Serge Doucet,MD,a Louis Leduc,MD,c Tack Ki Leung,MD,a Oscar Campuzano,PhD,d Anna Iglesias,BSc,MS,d Mario Talajic,MD,a and Ramon Brugada,MD,PhD d Montreal,and Quebec,Canada;and Girona,Spain

Background Sudden cardiac death(SCD)is the most common cause of death in adults aged b65years,making it a major public health problem.A growing incidence in coronary artery disease(CAD)in young individuals has been predicted in developed countries,which could in turn be associated with an increase in SCD in this population.The aim of the study was to assess the prevalence of CAD among autopsies of young individuals(b40years)who had sudden death(SD). Methods We selected all the autopsies referred to the Montreal Heart Institute and Maisonneuve-Rosemont Hospital from January2002to December2006that corresponded to individuals b40years old who had died suddenly.For each decedent, the following data were collected:cause of death,autopsy findings,available clinical history,toxicological findings,and cardiovascular risk factors.

Results From a total of1,260autopsies,243fulfilled the inclusion criteria.Coronary artery disease was the main cause of SCD from age20years,representing the37%of deaths in the group of21to30years old,and up to80%of deaths in the group of31to40years old.Among individuals who died of CAD,3-vessel disease was observed in39.7%of cases. Moreover,among the whole population b40years old,at least1significant coronary lesion was observed in39.5%of cases, irrespective to the cause of death.In the multivariable analysis,an increased BMI(hazard ratio1.1for each kg/m2,95%CI 1.01-1.1)and hypercholesterolemia(hazard ratio2.4,95%CI1.7-333.3)showed to be the modifiable factors related to an increased risk of SD from CAD.

Conclusions In our population,CAD was the main cause of SD from age20years.These data bring into question whether present prevention strategies are sufficient and reinforce the need to extend prevention to younger ages.(Am Heart J 2011;161:574-80.)

It is estimated that,every minute,a sudden cardiac death(SCD)occurs in the United States.Sudden cardiac death is the most common cause of death in adults aged b65years,making it a major public health problem in industrialized countries.1,2Coronary artery disease(CAD) is the leading cause of SCD in adulthood,being responsible for up to80%of cases of SCD.3Therefore, the impact of SCD is inexorably linked to CAD and will persist as long as CAD remains highly prevalent.Recent studies predict a rise in obesity and diabetes in developed countries,which is to be accompanied by a rise in CAD, affecting increasingly younger populations.4-6The rise in cardiovascular risk factors and,subsequently,CAD in the young population could lead to an increase in SCD from atherosclerotic origin in young individuals,but little information in this regard is available at present.

To assess the occurrence of CAD in young individuals and its role on SCD,we examined autopsies of individuals b40years old who died suddenly,evaluated the specific causes leading to death,and characterized the extent of CAD.In addition,we investigated the presence of possible,modifiable cardiovascular risk factors in indi-viduals with confirmed CAD.

Materials and methods

Study population

From January2002to December2006,all coroner autopsies of individuals b40years old who presented an out-of-hospital sudden death(SD)referred to the Montreal Heart Institute or Maisonneuve-Rosemont Hospital were collected prospectively.

From the a Montreal Heart Institute,University of Montreal,Montreal,Canada,b Institut Universitaire de Cardiologie et de Pneumologie de Québec,and UniversitéLaval,Quebec, Canada,c Maisonneuve-Rosemont Hospital,Montreal,Canada,and d Institut d'InvestigacióBiomèdica Girona(IDIBGI)and Universitat de Girona,Girona,Spain.

Submitted October12,2009;accepted October29,2010.

Reprint requests:Ramon Brugada,MD,FACC,Cardiovascular Genetics Center,Institut d'InvestigacióBiomèdica Girona,17003,Girona,Spain.

E-mail:ramon@http://www.doczj.com/doc/68e20cf4f705cc175527093b.html

0002-8703/$-see front matter

?2011,Mosby,Inc.All rights reserved.

doi:10.1016/j.ahj.2010.10.040