This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Burke, A. P. Articles by Virmani, R. Search for Related Content PubMed PubMed Citation Articles by Burke, A. P. Articles by Virmani, R. Pubmed/NCBI databases Medline Plus Health Information Cardiac Arrest Related Collections Primary prevention Other hypertension Acute coronary syndromes Epidemiology

(Circulation. 2002;105:419.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Traditional Risk Factors and the Incidence of Sudden Coronary Death With and Without Coronary Thrombosis in Blacks

Allen P. Burke, MD; Andrew Farb, MD; Joseph Pestaner, MD; Gray T. Malcom, PhD; Arthur Zieske, MD; Robert Kutys, MS; John Smialek, MD; Renu Virmani, MD

From the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (A.P.B., A.F., R.K., R.V.); Louisiana State University Health Science Center, New Orleans (G.T.M., A.Z.); and the University of Maryland, Baltimore (J.P., J.S.).

Correspondence to Renu Virmani, MD, Chairperson, Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306–6000. E-mail virmani{at}afip.osd.mil

Background— Blacks have a high rate of sudden coronary death (SCD). We determined the rate of SCD in men and women 30 to 69 years of age in a 6-year period recorded at a state Medical Examiner’s Office.

Methods and Results— In a subset of 327 whites and 130 blacks, hearts were systematically studied to determine the extent of coronary disease, presence and type of thrombus (acute rupture, acute erosion, stable plaque), and heart weight. These parameters were correlated with the presence of conventional risk factors. The estimated rate of SCD in blacks was similar to that in whites under the age of 40 years but increased compared with whites with advancing age, becoming 1.5 times the rate for whites in the 7th decade (95% of the increase in the 6th decade was due to sudden death with stable plaque). Among the autopsied group with severe coronary atherosclerosis, HDL cholesterol was higher and hypertension more prevalent in blacks, but there was no difference in the prevalence of healed infarcts, plaque burden, heart weight, acute thrombi, or rates of diabetes, cigarette smoking, and total cholesterol.

Conclusions— When compared with a control autopsy group of 568 deaths, multivariate analysis showed a significant association in blacks between stable plaque and left ventricular hypertrophy (risk ratio, 7.6), type 1 diabetes (risk ratio, 3.6), hypertension (risk ratio, 3.5), elevated total cholesterol (risk ratio, 3.1) and type 2 diabetes (risk ratio, 2.9). Because these risk factors are associated with SCD in blacks, they may be important targets for reducing the disparately high rate of SCD in blacks as compared with whites.

Key Words: hypertrophy • risk factors • thrombosis • death, sudden

This article has been cited by other articles:

				M. C.A. Kramer, S. Z.H. Rittersma, R. J. de Winter, E. R. Ladich, D. R. Fowler, Y.-H. Liang, R. Kutys, N. Carter-Monroe, F. D. Kolodgie, A. C. van der Wal, et al. Relationship of Thrombus Healing to Underlying Plaque Morphology in Sudden Coronary Death J. Am. Coll. Cardiol., October 7, 2009; (2009) j.jacc.2009.09.007v1. [Abstract] [Full Text] [PDF]

				N. R. Cook and M. A. Albert Regarding REGARDS: Does Inflammation Explain Racial and Regional Differences in Cardiovascular Disease Risk? Clin. Chem., September 1, 2009; 55(9): 1603 - 1605. [Full Text] [PDF]

				L. J. Shaw, R. E. Shaw, C. N. B. Merz, R. G. Brindis, L. W. Klein, B. Nallamothu, P. S. Douglas, R. J. Krone, C. R. McKay, P. C. Block, et al. Impact of Ethnicity and Gender Differences on Angiographic Coronary Artery Disease Prevalence and In-Hospital Mortality in the American College of Cardiology-National Cardiovascular Data Registry Circulation, April 8, 2008; 117(14): 1787 - 1801. [Abstract] [Full Text] [PDF]

				A. Paini, P. Boutouyrie, D. Calvet, M. Zidi, E. Agabiti-Rosei, and S. Laurent Multiaxial Mechanical Characteristics of Carotid Plaque: Analysis by Multiarray Echotracking System Stroke, January 1, 2007; 38(1): 117 - 123. [Abstract] [Full Text] [PDF]

				M. Valgimigli, G. A. Rodriguez-Granillo, H. M. Garcia-Garcia, P. Malagutti, E. Regar, P. de Jaegere, P. de Feyter, and P. W. Serruys Distance from the ostium as an independent determinant of coronary plaque composition in vivo: an intravascular ultrasound study based radiofrequency data analysis in humans Eur. Heart J., March 2, 2006; 27(6): 655 - 663. [Abstract] [Full Text] [PDF]

				A. Burke, W. Creighton, E. Mont, L. Li, S. Hogan, R. Kutys, D. Fowler, and R. Virmani Role of SCN5A Y1102 Polymorphism in Sudden Cardiac Death in Blacks Circulation, August 9, 2005; 112(6): 798 - 802. [Abstract] [Full Text] [PDF]

				L. J. Shaw, R. C. Hendel, M. Cerquiera, J. H. Mieres, N. Alazraki, E. Krawczynska, S. Borges-Neto, J. Maddahi, and C. N. Bairey Merz Ethnic Differences in the Prognostic Value of Stress Technetium-99m Tetrofosmin Gated Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1494 - 1504. [Abstract] [Full Text] [PDF]

				S. B. Kritchevsky, M. Cesari, and M. Pahor Inflammatory markers and cardiovascular health in older adults Cardiovasc Res, May 1, 2005; 66(2): 265 - 275. [Abstract] [Full Text] [PDF]

				P. K. MacCallum Markers of Hemostasis and Systemic Inflammation in Heart Disease and Atherosclerosis in Smokers Proceedings of the ATS, April 1, 2005; 2(1): 34 - 43. [Abstract] [Full Text] [PDF]

				M. A. Albert, J. Torres, R. J. Glynn, and P. M Ridker Perspective on Selected Issues in Cardiovascular Disease Research With a Focus on Black Americans Circulation, July 13, 2004; 110(2): e7 - e12. [Full Text] [PDF]

				A. P. Burke, F. D. Kolodgie, A. Zieske, D. R. Fowler, D. K. Weber, P. J. Varghese, A. Farb, and R. Virmani Morphologic Findings of Coronary Atherosclerotic Plaques in Diabetics: A Postmortem Study Arterioscler Thromb Vasc Biol, July 1, 2004; 24(7): 1266 - 1271. [Abstract] [Full Text] [PDF]

				R. P. Tracy Thrombin, Inflammation, and Cardiovascular Disease: An Epidemiologic Perspective Chest, September 1, 2003; 124 (2009): 49S - 57S. [Abstract] [Full Text] [PDF]

				A. P. Burke, R. Virmani, Z. Galis, C. C. Haudenschild, and J. E. Muller Task force #2--what is the pathologic basis for new atherosclerosis imaging techniques? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1874 - 1886. [Full Text] [PDF]

				B. J. Maron, K. P. Carney, H. M. Lever, J. F. Lewis, I. Barac, S. A. Casey, and M. V. Sherrid Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy J. Am. Coll. Cardiol., March 19, 2003; 41(6): 974 - 980. [Abstract] [Full Text] [PDF]

				A. Sambola, J. Osende, J. Hathcock, M. Degen, Y. Nemerson, V. Fuster, J. Crandall, and J. J. Badimon Role of Risk Factors in the Modulation of Tissue Factor Activity and Blood Thrombogenicity Circulation, February 25, 2003; 107(7): 973 - 977. [Abstract] [Full Text] [PDF]

				T. C. Lee, P. G. O'Malley, I. Feuerstein, and A. J. Taylor The prevalence and severity of coronaryartery calcification on coronary arterycomputed tomography in black and white subjects J. Am. Coll. Cardiol., January 1, 2003; 41(1): 39 - 44. [Abstract] [Full Text] [PDF]

				A. P. Burke, V. Fonseca, F. Kolodgie, A. Zieske, L. Fink, and R. Virmani Increased Serum Homocysteine and Sudden Death Resulting from Coronary Atherosclerosis With Fibrous Plaques Arterioscler Thromb Vasc Biol, November 1, 2002; 22(11): 1936 - 1941. [Abstract] [Full Text] [PDF]