Sudden cardiac death in women: causes of death at premenopausal and postmenopausal age

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Abstract Background Among women the incidence of sudden cardiac death (SCD) is lower than in men but still significant. On average menopause occurs at the age of 51.4 years. During the last decades the proportion of nonischemic SCD seems to have increased in both sexes. In postmenopausal women both the incidence and severity of the coronary artery disease (CAD) increase unpredictably 3-fold compared to premenopausal women of similar age. Purpose The aim of this study was to determine whether the causes of SCD differ among women at premenopausal and postmenopausal age. Methods The Fingesture study has systematically collected clinical and autopsy data from SCD victims in Northern Finland between 1998 and 2017. The cohort consists of 5,869 SCD victims of which 1,238 are women (21.1%). Women aged ≥52 years were considered as postmenopausal and ≤51 years old as premenopausal as the direct information of the menopause lacked due to the retrospective nature of this autopsy-based data. Results Approximately one fifth of the SCD victims were women (21.1%; P<0.001). The mean age of female subjects was 70.1±13.1 years (P<0.001). Only 7.9% of the women experienced SCD under the age of 52 years (P<0.001). Causes of death among women at premenopausal and postmenopausal age are represented in Table 1. Amongst all women 71.7% of the SCDs were ischemic (P<0.001). Majority of those women were at postmenopausal age but CAD caused still one third of the SCDs of the women at premenopausal age (33.7%, P<0.001). Overall nonischemic causes of death were more common at premenopausal age compared to postmenopausal women. Statistically significant nonischemic causes of death were primary myocardial fibrosis (PMF), obesity cardiomyopathy (CM), myocarditis, arrhythmogenic right ventricular cardiomyopathy (ARVC) and dilated CM. PMF was considerably more common cause of death among premenopausal women than in postmenopausal women (19.4 % vs. 3.9%, P<0.001), as was also the obesity CM (16.3% vs. 5.3%, P<0.001). Myocarditis caused the death of 5.1% of the premenopausal women but only 1.3% of the postmenopausal women (P=0.004). Both dilated CM (P=0.021) and ARVC (P=0.008) were the cause of death of 2.0% of the premenopausal women and 0.3-0.4% of the postmenopausal women. Subjects with anatomically and histologically normal finding at autopsy were mainly at premenopausal age (2.0% vs. 0.3%, P=0.008) even though the overall amount of cases remained low. Conclusions SCD at premenopausal age is rare. One third of the premenopausal SCDs are ischemic even though majority of the SCDs at premenopausal age are nonischemic etiology. Especially the prevalence of PMF and obesity CM were remarkably higher among premenopausal women compared to the postmenopausal age group emphasizing the role of genetics and lifestyle behind the SCD of premenopausal women.Table 1.

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