Abstract 15915: Sudden Cardiac Death in Blacks versus Whites: A Closer Look at Coronary Pathology
Introduction: From a community-based study, we have recently reported a higher burden of sudden cardiac death (SCD) in blacks compared to whites, with significant differences in demographic and clinical profile. Coronary artery disease (CAD) is commonly associated with SCD, but due to low rates of postmortem evaluation in the community, there is limited information regarding possible race-related differences in pathophysiology of coronary disease.
Methods: From an established, dedicated cardiac pathology database in Eastern US, we compared 133 consecutive black SCD subjects, to 195 white SCD subjects (2005-2010). Detailed clinical and autopsy data including cardiac and coronary gross and histopathology findings were compared.
Results: Consistent with our published community-based findings, blacks were found to be significantly younger than whites (54.8 ± 14.6 yr vs 60.6 ± 14.1 yr; p <0.01), and more likely to be female (32% vs 23%; p =0.07). There were no significant differences in mean height (Blacks, 175 ± 12 cm vs Whites, 175 ± 10 cm; p=0.83), weight (Blacks, 94 ± 25 vs Whites, 90 ± 25 kg; p=0.15) and body mass index (Blacks, 30.6 ± 6.8 vs Whites, 29.2 ± 7.1; p=0.09) between the groups. Mean heart weight (Blacks, 526 ± 151 g vs Whites, 509 ± 137 g; p=0.3) and left ventricular cavity dimensions (Blacks, 37 ± 8.7 mm vs Whites, 36.8 ± 8.4 mm; p=0.84) were not significantly different between the groups. Blacks had a higher prevalence of cardiovascular risk factors such as hypertension (55% vs 37%; p <0.01) and diabetes mellitus (22% vs 9%; p <0.01). Blacks were more likely to suffer SCD without significant CAD (61% vs 31%; <0.01). The prevalence of severe CAD (>75% stenosis in any major coronary artery) was lower in Blacks (27% vs 44%; p <0.01), as was acute coronary thrombosis (12% vs 24%; p <0.01). Blacks were less likely to have chronic total occlusion (23% vs 47%; p<0.01) and healed myocardial infarction (36% vs 52%; p =0.02).
Conclusions: Blacks have higher rates of SCD in the absence of significant CAD, chronic total occlusion or acute thrombosis, at least partly explained by presentation at younger age. These findings suggest greater involvement of non-coronary etiologies among Black SCD cases, and highlight the potential importance of race-specific prevention.
Author Disclosures: S.G. Nair: None. H. Mori: None. K. Reinier: None. A.L. Aro: None. F. Kolodgie: None. R. Virmani: None. S.S. Chugh: Research Grant; Significant; NIH (NHLBI), R01HL126938 and R01HL122492.
- © 2016 by American Heart Association, Inc.