Gender differences in cardiovascular causes of sudden cardiac death in the young

Abstract

Purpose: Sudden cardiac death (SCD) in the young is due to a wide spectrum of cardiovascular causes but few studies specifically addressed their prevalence and characteristics in the female (F) vs. male (M) gender. Methods: In the time interval 1980-2011, 591 SCDs in young people aged 1-40 yrs (mean age 259 yrs) have been prospectively studied according to a uniform pathology protocol in our referral pathology Centre. Results: They were 406 M (69%) and 185 F (31%), mean age 268 vs. 2410, p=0.01. Major causes included atherosclerotic coronary artery disease (CAD 108, 18%), myocarditis (72, 12%), arrhythmogenic right ventricular cardiomyopa-thy (ARVC 58, 10%), hypertrophic cardiomyopathy (HCM 55, 9%), dilated car-diomyopathy (22, 4%), non ath-CAD (41, 7%) and mitral valve prolapse (MVP 45, 7.5%). In 37 cases SCD was mechanical (6%) and in 101 (17%) the heart was structurally normal (unexplained SCD). Among cardiomyopathies, myocarditis, HCM and DCM show an almost equal prevalence in M and F (11%, 10% and 4% vs. 15%, 7% and 3.5%, respectively, p=NS). Atherosclerotic CAD (24% vs. 6%) and ARVC (13% vs. 3%) are the leading causes in M SCD victims. On the contrary, spontaneous coronary artery dissection (5% vs. 0.2%), MVP (14% vs. 5%) and mechanical causes (9% vs. 5%) are more typical of F SCD victims. SCD remains unexplained in 25% of F vs. 13.5% of M. Competitive sport activity is more frequent in M than F (17% vs. 3%). All p are statistically significant. Among F cases aged 18 yrs, 12% died suddenly during pregnancy or in the peri-partum period. Conclusion: One third of young SCD victims are women. In the F gender, SCD remains unexplained in one forth of cases and major cardiovascular causes are represented by subtle substrates such as myocarditis and MVP. Athletic activity is underrepresented as compared to M, possibly explaining the low prevalence of ARVC among F SCD victims at difference from other inherited cardiomyopathies.