Background: Recognition of potentially lethal heart disease remains a major challenge, especially in women, who are significantly less likely than men to have a diagnosis of coronary disease prior to sudden cardiac arrest (SCA).
Objective: We hypothesized that lower recognition of heart disease preceding SCA in women is driven by a lower cardiovascular risk profile.
Methods: From the Oregon Sudden Unexpected Death Study (Oregon SUDS), an ongoing prospective community-based study of out of hospital cardiac arrest in the Portland, OR metro area, we evaluated SCA cases age ≥18 enrolled from Feb. 2002 - Jan. 2016, comparing prevalence of CAD and cardiovascular (CV) risk factors by sex. CAD was defined as a history of MI or revascularization, or a finding of ≥50% stenosis on coronary angiogram or autopsy. CV risk factors were defined as hypertension, hyperlipidemia, obesity, smoking, and diabetes.
Results: From 2002-2016, 3805 SCD cases with medical records available prior to arrest were included in the analysis. Among women, 67% had no medically-documented history of CAD, while among men, 57% had no history of CAD (p<0.001). In the subset of SCA cases with no established history of CAD, women were significantly older than men (68.2 ± 17.6 vs 61.3 ± 16.1, p<0.001). Women were more likely than men to have diagnosed hypertension (69% vs 57%, p<0.001) and less likely to be a current smoker (24% vs 31%, p<0.001), but had a similar history of hyperlipidemia, obesity, and diabetes. Among patients with no history of CAD and an evaluation at the time of SCA (n=1008), 39% of women and 51% of men (p<0.001) had significant CAD discovered despite having no history of CAD. Sixty-one percent of women and 59% of men (p=0.80) with SCD as the first manifestation of CAD had at least two CV risk factors. Among those without CAD discovered at arrest, 61% of women and 49% of men (p=0.03) had at least two CV risk factors.
Conclusion: Contrary to expectations, the cardiovascular risk profile was equivalent or higher in women who suffered SCA even though CAD was less prevalent compared to men. For prevention of sudden death as the first manifestation of heart disease, aggressive management of non-coronary SCA etiologies may be even more important in women compared to men.