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Age and Sex Differences in the Risk of Sudden Cardiac Death in Patients with Hypertrophic Cardiomyopathy: A
Huihui Ma1,2, Fengcheng Xu3,4, Lei Liu5
1School of Medicine, University of Electronic Science and Technology of China, Institute of Cardiovascular Diseases & Department of Cardiology, Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China.
Insights
Age is a significant predictor of sudden cardiac death (SCD) risk in hypertrophic cardiomyopathy (HCM) patients, particularly for females. Prognosis varies across age groups, with younger patients facing higher risks.
Area of Science:
- Cardiology
- Genetics
- Public Health
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex genetic heart condition with variable patient prognosis.
- Sudden cardiac death (SCD) is a primary concern in HCM management.
- Prognostic differences across age and gender groups in HCM require further investigation.
Purpose of the Study:
- To investigate the association between age, gender, and the risk of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM).
- To identify age- and gender-specific risk factors for SCD in an HCM cohort.
Main Methods:
- A cohort of 2781 HCM patients (1996-2023) was analyzed, with follow-up for a median of 4.54 years.
- Patients were stratified into three age groups: ≤40 (youth), 40-60 (middle-aged), and ≥60 (elderly).
- Kaplan-Meier curves, Cox regression, and restricted cubic splines were used to assess SCD risk across age and gender.
Main Results:
- SCD occurred in 4.6% of the cohort (128 patients).
- Age was a significant independent predictor of SCD in the overall population (HR: 0.983, P=0.003) and in female patients (HR: 0.963, P<0.001).
- Age was not a significant predictor of SCD in male patients (HR: 0.995, P=0.538).
Conclusions:
- Age independently predicts SCD risk in the overall HCM population and specifically in females.
- Middle-aged and elderly female HCM patients demonstrated significantly reduced SCD risk compared to younger females.
- Risk reduction in middle-aged and elderly males was less pronounced than in females, highlighting gender-specific prognostic differences.
Objective:
There is a significant difference in prognosis among patients with hypertrophic cardiomyopathy (HCM) across different age groups and gender groups. This study aims to explore the risk of sudden cardiac death (SCD) in various age groups and genders.
Methods:
A cohort of 2781 patients with HCM, initially evaluated between 1996 and 2023, were followed for a median of 4.54 years. The patients were divided into three age groups: youth group (aged ≤ 40 years), middle-aged group (aged between 40 and 60 years), and elderly group (aged ≥60 years). The outcome event was (SCD). Kaplan-Meier survival curves and Cox regression analysis were employed to compare outcomes across different age groups for both genders. Additionally, restricted cubic splines (RCS) were utilized to evaluate the potential relationship between age and prognosis within different gender categories.
Results:
A total of 128 patients (4.6%) experienced SCD. In the whole population, significant age differences were observed in the Kaplan-Meier survival curves for SCD (log-rank P<0.0001). Significant age differences in SCD were also noted in both genders (log-rank P<0.0001). In multivariate Cox regression analysis, age was an independent predictor of SCD in the whole population [HR: 0.983; 95% CI: 0.972-0.994; P=0.003] and female patients [HR: 0.963; 95% CI: 0.947-0.98; P<0.001]. However, it was not significant in male patients [HR: 0.995; 95% CI: 0.98-1.01; P=0.538].
Conclusion:
In patients with HCM, age was an independent predictor of SCD both the whole population and female patients. Compared to young patients, the risk of SCD is reduced by 71.4% in middle-aged patients and by 43.5% in elderly patients across the whole population. Among male patients, the risk of SCD decreases by 68.5% in middle-aged patients and by 10.7% in elderly patients. In female patients, the risk of SCD is reduced by 77.8% in middle-aged patients and by 75.3% in elderly patients.
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