Burden of cardiovascular disease in victims of fatal intoxication: An autopsy study

Previous post-mortem studies in victims of intoxication have typically focused on toxicological and biochemical analyses. This study aimed to assess the prevalence and types of cardiovascular disease in fatal intoxication cases.

We included post-mortem autopsy examinations of 865 fatal intoxication cases performed on medico-legal basis at the Gade Laboratory for Pathology at Haukeland University Hospital, Bergen between 2000 and 2013.

The mean age at death was 42.1 years (range 13-97) and 72% were males. The cause of death was attributed to intoxication with drugs in 35% cases, combination of drugs and narcotics in 17%, narcotics in 17%, ethanol and drugs in 15%, and ethanol alone in 8% cases. More than a third (36.0%) had concomitant causes of death. The mean heart weight was 387 ± 86 g. A total of 12.3% patients had mild, 8.4% moderate and 9.7% had severe atherosclerosis, while 69.6% had no atherosclerosis or only minor changes in the coronary arteries. A total of 14.9% patients had pathological changes in the brain: cerebral oedema in 23% (n = 29) cases, old ischemic strokes in 22% (n = 28), traumatic brain injury in 13.2% (n = 17) and intracranial hemorrhage in 8.5% (n = 11), while the incidence of acute ischemic stroke was 3.1% (n = 4). Myocardial infarction (old/healed) was evident in 10.3% (n = 89) of the victims. The incidence of left ventricular hypertrophy was nearly 3-fold higher than right ventricular hypertrophy (29.2% vs 10.6%).

In victims of intoxication, cerebrovascular disease was found in 15% and heart diseases in up to 30% of cases. It is possible that the acute toxic effects of alcohol and substance abuse are aggravated in patients with underlying cardiac and cerebrovascular diseases. The findings from the current study highlight the importance of enhanced cardiovascular risk assessment in substance use disorders, with major forensic and public health implications.