title: Risk Factors for Sudden Cardiac Death Among Patients with Alcohol Dependence: A Nested Case-Control Study.
abstract: BACKGROUND
  Excessive alcohol consumption causes a broad range of health problems, including premature mortality and sudden cardiac death (SCD). We identified potential clinical characteristics and laboratory indices associated with SCD among patients with alcohol dependence.
  
  
  METHODS
  Patients with alcohol dependence (n = 2,793) admitted to a psychiatric center in northern Taiwan between 1985 and 2008 were linked with a national mortality database for causes of death. Of the 2,793 patients in the cohort, 67 cases died of SCD. The standardized mortality ratio (SMR) of SCD relative to the general population was calculated. Based on a nested case-control design, we selected a set of sex-, age-, and year-of-admission-matched two control subjects for each case derived from the cohort. We collated the clinical information through a standardized review of patients' medical records. Conditional logistic regressions were then conducted to explore potential exposures associated with SCD.
  
  
  RESULTS
  The sample had substantially higher SCD mortality (SMR 12.8) compared to the general population. After adjustments in the multivariate analyses for the clinical profiles at the index (earliest) admission, both abnormal electrocardiography (ECG) (adjusted risk ratio = 16.97, 95% confidence interval (CI) 1.60 to 179.58, p = 0.019) and elevated aspartate aminotransferase levels (adjusted risk ratio = 1.01, 95% CI 1.00 to 1.02, p = 0.046) were significantly associated with SCD.
  
  
  CONCLUSIONS
  This study raises the question of whether intensive follow-up of patients with elevated AST and abnormal ECG findings should be evaluated as a strategy to prevent SCD in patients with alcohol dependence.
authors.affiliation: Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.|Department of Audiology and Speech and Language Pathology, Mackay Medical College, Taipei, Taiwan.
authors.forename: Shu-I
authors.initials: SI
authors.lastname: Wu
authors.affiliation: Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan.|Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Shang-Ying
authors.initials: SY
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan.|Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.|Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Ming-Chyi
authors.initials: MC
authors.lastname: Huang
authors.affiliation: King's College London, Institute of Psychiatry, London, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan.|Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.|Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Chian-Jue
authors.initials: CJ
authors.lastname: Kuo
authors.affiliation: Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.|Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan.|Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.|Department of Psychiatry, Mackay Medical College, Taipei, Taiwan.
authors.forename: Chiao-Chicy
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases
keywords: Alcohol Dependence; Electrocardiography; Risk Factor; Sudden Cardiac Death