Cardiac Pathologic Findings Reveal a High Rate of Sudden Cardiac
Background: Between 1989 and 1998 there was a 21% increase in estimated sudden cardiac death among US women aged 35 to 44 years. In contrast, the sudden cardiac death rate in age-matched men showed a decreasing trend (-2.8%). Due to under-representation of younger adults in published autopsy series, etiologies of sudden cardiac death merit further investigation.
Methods: We reviewed autopsy and detailed cardiac pathologic findings in younger women (age 35-44 years) from a 270-patient, 13-year (1984-1996) autopsy series of sudden cardiac death, and performed comparisons with findings in age-matched men.
Results: Women aged 35 to 44 years constituted 32% of all women in the series compared to men, who constituted 24% of total men (P = .004 vs women). A presumptive cause of sudden cardiac death could not be determined in 13 women (50%). Among women, 6 cases (22%) had significant coronary artery disease. Findings in others included coronary artery anomalies (n = 3), myocarditis (n = 2), hypertrophic cardiomyopathy (n = 1), coronary artery dissection (n = 1) and accessory pathway (n = 1). In younger men, a presumptive cause of sudden cardiac death remained undetermined in only 24% (P = .025 vs younger women), and coronary artery disease accounted for 40% of cases.
Conclusions: In younger women, despite autopsy and detailed cardiac pathologic examination, an attributable cause of sudden cardiac death was not determined in 50% of cases; a 2-fold increase compared to men of the same age. Given the dynamic and multifactorial nature of sudden cardiac death, comprehensive population-based investigations are likely to be necessary to further investigate this unexpected sex-based disparity.

Recent surveillance data (1989-1998) have revealed alarming trends for sudden cardiac death in younger US women. Although sudden cardiac death rates declined in all other adults aged >35 years, there was a 21% increase in the rate for women aged 35 to 44 years over this 10-year period. In contrast, younger men were observed to have decreasing rates of sudden cardiac death. The cause/causes of the disproportionately increased sudden cardiac death rate in younger women remains unknown.

Because women are exposed to fewer traditional risk factors for sudden cardiac death than men, primary prevention and risk stratification may be most challenging in women. This is especially true for younger women, who have the lowest incidence of coronary artery disease. Although sudden cardiac death is likely to be a dynamic, multifactorial process, autopsy and detailed cardiac pathologic evaluation can often identify an attributable etiology of sudden cardiac death. However, women aged 35 to 44 years are poorly represented in available autopsy series. We evaluated autopsy findings and detailed cardiac pathology after sudden cardiac death in this subgroup and compared them to age-matched men from a 13-year (1984-1996) autopsy series of sudden cardiac death.