Cardiac Symptoms Before SCD Caused by CAD
Objective The aim of this nationwide case–control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD).
Methods We have previously investigated the incidence of sudden cardiac death (SCD) in young Danish people aged 1–35 years in Denmark during 2000–2006. We included all deaths (n=6629) and identified 314 autopsied cases of SCD, 40 of whom (13%) died from CAD. To compare symptoms before death, the CAD case group was sex- and age-matched 1:2 with a control group randomly sampled from a population of 1497 individuals who had died in accidents. We used data from the National Patient Registry on previous contacts with the healthcare system for all persons and read all available patient records, including death certificates and autopsy reports.
Results A total of 31 (79%) persons with CAD-SCD had cardiac symptoms such as angina pectoris (n=24, 62%) and dyspnoea during the 12 months before death, and this was significantly higher than in the control group (p<0.001). In the case group, 18 persons (46%) had contacts with the healthcare system for cardiac symptoms before death, and this was also significantly higher than the control group (p<0.001).
Conclusions In this nationwide study we found that 62% of young persons with SCD experienced angina before death, and nearly half of them who died of CAD had sought medical attention within the last year before death.
Sudden cardiac death (SCD) is the most common cause of death in Western countries and, in the USA alone, it accounts for 180 000–450 000 deaths annually. In adults, coronary artery disease (CAD) and its consequence in the form of acute myocardial infarction (MI) is the cause of 75% of all SCDs. Cardiovascular risk factors in elderly and middle-aged patients are well known, but only a few studies have investigated cardiovascular risk factors in young patients with MI. These studies have shown that smoking, a family history of CAD and dyslipidaemia are the most important risk factors in young patients with MI. We have previously shown that prior MI at a young age (1–35 years) significantly increases the incidence of SCD. Several studies, mostly based on autopsy and death certificates, have found CAD or even structurally normal heart (presuming cardiac arrhythmia) as the major cause of SCD in young persons. A family history of premature cardiovascular death has been associated with a risk of early cardiovascular disease, and a hereditary disposition to SCD and CAD has been suggested in several population studies in adults.
In the young, it is evident that SCD is linked to CAD and therefore the relatively frequent occurrence of SCD will persist as long as CAD remains highly prevalent. Despite the extensive research into young persons with SCD, prevention remains challenging. Limited information is available regarding cardiac symptoms in CAD-SCD persons before death. Given the low likelihood that acute coronary syndrome is the cause of chest pain in individuals younger than 40 years, it is often difficult for physicians to identify those individuals at high risk of MI and thereby SCD. By studying the symptoms of CAD before death in young adults, we may get closer to identifying these young persons in time to prevent premature death. To date, no studies have systematically investigated cardiac symptoms in detail before death in individuals with CAD-SCD.
The aim of this nationwide study was to identify and characterise symptoms before death of autopsied persons with SCD who had died due to CAD and to compare these persons with a matched control group who had died from accidental causes.
Abstract and Introduction
Abstract
Objective The aim of this nationwide case–control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD).
Methods We have previously investigated the incidence of sudden cardiac death (SCD) in young Danish people aged 1–35 years in Denmark during 2000–2006. We included all deaths (n=6629) and identified 314 autopsied cases of SCD, 40 of whom (13%) died from CAD. To compare symptoms before death, the CAD case group was sex- and age-matched 1:2 with a control group randomly sampled from a population of 1497 individuals who had died in accidents. We used data from the National Patient Registry on previous contacts with the healthcare system for all persons and read all available patient records, including death certificates and autopsy reports.
Results A total of 31 (79%) persons with CAD-SCD had cardiac symptoms such as angina pectoris (n=24, 62%) and dyspnoea during the 12 months before death, and this was significantly higher than in the control group (p<0.001). In the case group, 18 persons (46%) had contacts with the healthcare system for cardiac symptoms before death, and this was also significantly higher than the control group (p<0.001).
Conclusions In this nationwide study we found that 62% of young persons with SCD experienced angina before death, and nearly half of them who died of CAD had sought medical attention within the last year before death.
Introduction
Sudden cardiac death (SCD) is the most common cause of death in Western countries and, in the USA alone, it accounts for 180 000–450 000 deaths annually. In adults, coronary artery disease (CAD) and its consequence in the form of acute myocardial infarction (MI) is the cause of 75% of all SCDs. Cardiovascular risk factors in elderly and middle-aged patients are well known, but only a few studies have investigated cardiovascular risk factors in young patients with MI. These studies have shown that smoking, a family history of CAD and dyslipidaemia are the most important risk factors in young patients with MI. We have previously shown that prior MI at a young age (1–35 years) significantly increases the incidence of SCD. Several studies, mostly based on autopsy and death certificates, have found CAD or even structurally normal heart (presuming cardiac arrhythmia) as the major cause of SCD in young persons. A family history of premature cardiovascular death has been associated with a risk of early cardiovascular disease, and a hereditary disposition to SCD and CAD has been suggested in several population studies in adults.
In the young, it is evident that SCD is linked to CAD and therefore the relatively frequent occurrence of SCD will persist as long as CAD remains highly prevalent. Despite the extensive research into young persons with SCD, prevention remains challenging. Limited information is available regarding cardiac symptoms in CAD-SCD persons before death. Given the low likelihood that acute coronary syndrome is the cause of chest pain in individuals younger than 40 years, it is often difficult for physicians to identify those individuals at high risk of MI and thereby SCD. By studying the symptoms of CAD before death in young adults, we may get closer to identifying these young persons in time to prevent premature death. To date, no studies have systematically investigated cardiac symptoms in detail before death in individuals with CAD-SCD.
The aim of this nationwide study was to identify and characterise symptoms before death of autopsied persons with SCD who had died due to CAD and to compare these persons with a matched control group who had died from accidental causes.