Coronary artery disease is the most common cause of sudden cardiac death, even among young adults – autopsies often reveal advanced cardiac disease

Coronary artery disease is the most common cause of sudden cardiac death at the demographic level. Various structural cardiac and arrhythmia disorders stand out among the younger population. Although coronary artery disease is mainly considered to affect the older population, its significance among young people has now been recognised, too. In contrast to other causes of sudden cardiac death among young people, coronary artery disease is a preventable and treatable disease.

The aim of the study was to investigate the causes of sudden cardiac deaths among young and middle-aged people under the age of 50, as well as the typical characteristics of sudden deaths related to coronary artery disease and autopsy findings. Another objective was to assess the proportion of sudden cardiac death caused by coronary artery disease among different age groups and its occurrence over the past 20 years.

The study used the FinGesture data, which consists of all the deceased shown to have died from sudden cardiac death in a forensic autopsy in the region of Northern Finland in 1998–2017 (n = 5,869). Among this study population, a total of 610 victims (10%) were under the age of 50 and the majority of them were male (86%).

Coronary artery disease was the most common cause of sudden cardiac death among people under the age of 50 (266 victims, 44%). The proportion of sudden deaths from coronary artery disease among all causes increased constantly by age group, being the lowest among those aged under 30 (7%) and the highest among those aged 45–50 (50%). Over the past 20 years, the proportion of sudden deaths from coronary artery disease among young people has decreased, which has also been previously observed for the entire population.

The majority (90%) of the victims of sudden death from coronary artery disease had not been diagnosed with coronary artery disease before their death. Nine out of ten of the victims were male. More than half of the young victims under the age of 50 years had at least one risk factor associated with cardiovascular diseases, which also highlights the importance of early screening and preventative measures among the younger population. For example, one third of the victims were known to be smokers. In addition to acquired risk factors, one third of the victims had a known case of sudden cardiac death in their family. A quarter of the victims had died during physical exertion.

Despite their young age, a significant proportion of the victims of sudden death from coronary artery disease had an advanced coronary artery disease that was detectable in an autopsy. For example, triple-vessel coronary artery disease, cardiac fibrosis and cardiac hypertrophy were common findings in the autopsies of the young victims.

It is generally known that the development of coronary artery disease begins gradually by puberty, at the latest. However, these current research findings suggest that coronary artery disease may be highly advanced despite the patient’s young age, which emphasises the need for early detection of coronary artery disease and the risk factors associated with it as well as the importance of screening among young adults.

Article: Vähätalo J, Holmström L, Pakanen L, Kaikkonen K, Perkiömäki J, Huikuri H, Junttila J. Coronary Artery Disease as the Cause of Sudden Cardiac Death Among Victims < 50 Years of Age. The American Journal of Cardiology, 2021.