Sudden unexpected death in women: biologic and psychosocial origins

The relationship of the risk of sudden death from arteriosclerotic heart disease to biologic and psychosocial factors was studied retrospectively in Allegheny County, Pennsylvania, in 80 white women who died from arteriosclerotic heart disease during March, 1977-October, 1978, and in 80 age-matched neighborhood controls. All cases of sudden death in white women aged 25-64 years who died outside the hospital within 24 hours of onset of symptoms were ascertained. The overall autopsy rate was 63%. Detailed post-mortem examinations were conducted on 42 of 80 sudden cardiac cases. Cases were more often heavy smokers and had fewer children than the control population. Fifteen out of 80 women who died suddenly of heart disease and three controls had a definite history of psychiatric disease. Cases had more often experienced the death of a significant other within six months prior to their demise. Multiple regression analysis showed that cigarette smoking, psychiatric history and death of a significant other contributed significantly to differences between women who died suddenly and control women. Thirteen women died suddenly under the age of 45 years. Six of the 13 deaths were due to arteriosclerotic heart disease. These six women were all smokers, and four were currently taking oral contraceptives or estrogen replacements.