title: Cardiac pathologic findings reveal a high rate of sudden cardiac death of undetermined etiology in younger women.
abstract: BACKGROUND
  Between 1989 and 1998 there was a 21% increase in estimated sudden cardiac death among US women aged 35 to 44 years. In contrast, the sudden cardiac death rate in age-matched men showed a decreasing trend (-2.8%). Due to under-representation of younger adults in published autopsy series, etiologies of sudden cardiac death merit further investigation.
  
  
  METHODS
  We reviewed autopsy and detailed cardiac pathologic findings in younger women (age 35-44 years) from a 270-patient, 13-year (1984-1996) autopsy series of sudden cardiac death, and performed comparisons with findings in age-matched men.
  
  
  RESULTS
  Women aged 35 to 44 years constituted 32% of all women in the series compared to men, who constituted 24% of total men (P =.004 vs women). A presumptive cause of sudden cardiac death could not be determined in 13 women (50%). Among women, 6 cases (22%) had significant coronary artery disease. Findings in others included coronary artery anomalies (n = 3), myocarditis (n = 2), hypertrophic cardiomyopathy (n = 1), coronary artery dissection (n = 1) and accessory pathway (n = 1). In younger men, a presumptive cause of sudden cardiac death remained undetermined in only 24% (P =.025 vs younger women), and coronary artery disease accounted for 40% of cases.
  
  
  CONCLUSIONS
  In younger women, despite autopsy and detailed cardiac pathologic examination, an attributable cause of sudden cardiac death was not determined in 50% of cases; a 2-fold increase compared to men of the same age. Given the dynamic and multifactorial nature of sudden cardiac death, comprehensive population-based investigations are likely to be necessary to further investigate this unexpected sex-based disparity.
authors.affiliation: Division of Cardiology, Oregon Health and Science University, Portland, Ore 97239, USA. chughs@ohsu.edu
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
authors.forename: Kiyon
authors.initials: K
authors.lastname: Chung
authors.forename: Zhi-Jie
authors.initials: ZJ
authors.lastname: Zheng
authors.forename: Benjamin
authors.initials: B
authors.lastname: John
authors.forename: Jack L
authors.initials: JL
authors.lastname: Titus
mesh_terms: D000328:Adult; D001344:Autopsy; D003327:Coronary Disease / Q000473:pathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology*; D008297:Male; D008945:Mitral Valve Prolapse / Q000473:pathology*; D009206:Myocardium / Q000473:pathology