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Sudden cardiac death in South India: Incidence, risk factors and pathology
Uma N Srivatsa1, K Swaminathan2, K Sithy Athiya Munavarah2
1University of California (Davis) Medical Center, Sacramento, CA, United States.
Insights
Sudden cardiac death (SCD) predominantly affects men in South India, often linked to acute myocardial infarction (MI). Understanding the pathology and risk factors is crucial for targeted prevention strategies in this population.
Area of Science:
- Cardiology
- Public Health
- Pathology
Background:
- Sudden cardiac death (SCD) is a significant cause of mortality in industrialized nations, particularly among those with coronary artery disease (CAD).
- The prevalence and pathological basis of SCD in the South Asian population, despite their high CAD rates, remain largely uncharacterized.
Purpose of the Study:
- To investigate the frequency and underlying cardiac pathology of sudden cardiac death (SCD) in a South Indian population.
- To determine the demographic characteristics and etiological factors associated with SCD in this region.
Main Methods:
- A retrospective review of medical records for patients experiencing unexplained sudden death (USD) was conducted.
- Cases involving trauma, toxicology, or non-cardiac causes were excluded, with cardiac pathology confirmed via autopsy.
- Sudden cardiac death (SCD) rates were calculated using census and vital statistics data.
Main Results:
- During a two-year period, 223 patients presented with USD; SCD was attributed to myocardial infarction (MI) in 87% of cases.
- Acute anterior MI was common (69%), with small to moderate infarct sizes predominating (76%).
- The estimated SCD rate in individuals over 35 years was 39.7 per 100,000, with a male-to-female ratio of 4.6:1.
Conclusions:
- Sudden cardiac death (SCD) in this South Indian cohort primarily occurred in relatively young men and was frequently associated with acute MI.
- Findings suggest a need for improved healthcare access, preventive strategies, and emergency management to mitigate SCD from acute MI in this locale.
Background:
Sudden cardiac death (SCD) is a major cause of mortality secondary to coronary artery disease (CAD) in the industrialized societies. Although South Asians have a high prevalence of CAD, the frequency and underlying pathology of SCD among this population are unknown.
Methods:
Medical records of consecutive patients presenting with unexplained sudden death (USD) in a tertiary care center were reviewed. Patients with trauma, violent deaths, positive toxicology and non-cardiac pathology were excluded to determine sudden cardiac death (SCD). Cardiac pathological findings were analyzed by autopsy. SCD rate was estimated based on census and government vital statistics for the years studied.
Results:
During a two year period, 223 patients (mean age 55 + 10 yrs, 78.9% male, body mass index 26 + 4, 60% smokers, 39% known CAD, 46% hypertension, 43% diabetes) presented to hospital with USD. SCD was attributed to myocardial infarction (MI) in 87% of cases; 69% were acute (96% anterior MI); 76% were small/moderate infarct and 9.9% of the cohort had normal hearts. Based on official municipal vital statistics, the SCD rate in those >35 yrs of age was estimated as 39.7/100,000 with male/female ratio of 4.6.
Conclusions:
SCD in this south Indian city occurred predominantly in men of relatively young age and was most frequently associated with small or moderate-sized acute MI. Improved health care access, preventive measures and enhanced emergency management may reduce SCD from acute MI in this locale.
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