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QUARTERLY FOCUS ISSUE: HEART RHYTHM DISORDERS: CLINICAL RESEARCH

Women Have a Lower Prevalence of Structural Heart Disease as a Precursor to Sudden Cardiac Arrest

The Ore-SUDS (Oregon Sudden Unexpected Death Study)

Sumeet S. Chugh, MD^_*,_*, Audrey Uy-Evanado, MD^_*, Carmen Teodorescu, MD, PhD^_*, Kyndaron Reinier, PhD, MPH^_*, Ronald Mariani, EMT-P^_*, Karen Gunson, MD and Jonathan Jui, MD, MPH

^_* Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
Department of Pathology, Oregon Health and Science University, Portland, Oregon

Manuscript received February 25, 2009; revised manuscript received June 18, 2009, accepted July 21, 2009.

^_* Reprint requests and correspondence: Dr. Sumeet S. Chugh, The Heart Institute, 5702 South Tower, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048 (Email: sumeet.chugh{at}cshs.org).

Objectives: Our aim was to utilize a community-based approach to identify sex-related differences in risk factors for sudden cardiac arrest (SCA).

Background: There are significant sex-based differences in prevalence and manifestation of SCA. Any differences related to predictors of SCA in women versus men are likely to have implications for risk stratification and prevention.

Methods: The Ore-SUDS (Oregon Sudden Unexpected Death Study) is an ongoing prospective investigation of SCA in the Portland, Oregon, metropolitan area (population approximately 1 million). All cases meeting criteria for SCA were ascertained using multiple sources. Medical records were reviewed to identify clinical conditions that may contribute to SCA risk, and comparisons were made between male and female SCA cases using Pearson's chi-square tests for categorical variables, t tests for continuous variables, and multivariate logistic regression analysis.

Results: During 2002 to 2007, 1,568 adult SCA cases were identified (women 36% vs. men 64%; p < 0.0001) and women were older (mean age 71 ± 14 years vs. 65 ± 14 years, p < 0.0001). There were no significant sex differences in prevalence of obesity, dyslipidemia, history of chronic obstructive pulmonary disease/asthma, left ventricular (LV) hypertrophy, or history of myocardial infarction. In multivariate analysis, women were significantly less likely to have severe LV dysfunction (odds ratio: 0.51; 95% confidence interval: 0.31 to 0.84) or previously recognized coronary artery disease (odds ratio: 0.34; 95% confidence interval: 0.20 to 0.60) compared with men.

Conclusions: Women were significantly less likely than men to have a diagnosis of structural heart disease (LV dysfunction or coronary artery disease) before SCA. These findings suggest that fewer women may be eligible for prophylactic implantable cardioverter-defibrillator placement based on current guidelines and therefore may not have equal opportunity for prevention. Enhancement of SCA risk stratification may have even higher importance for women.

Key Words: death, sudden • sex • ejection fraction • coronary artery disease • risk stratification • population

Abbreviations and Acronyms   CAD = coronary artery disease   CI = confidence interval   DM = diabetes mellitus   ICD = implantable cardioverter-defibrillator   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   LVM = left ventricular mass   PEA = pulseless electrical activity   QTc = corrected QT interval   SCA = sudden cardiac arrest