Trends and characteristics of sudden cardiac death due to aortic diseases in the young

Abstract Background Sudden Cardiac Death (SCD) in young individuals is a devastating event, often occurring without prior symptoms. While most SCD cases result from arrhythmias or ischemic heart disease, aortic pathology, though rare, is lethal and can mimic myocardial infarction. Several risk factors contribute to aortic pathology, including lifestyle factors like hypertension and smoking. However, in younger individuals, hereditary conditions may play a major role. T Purpose The purpose of this study is to provide an overview of SCD due to aortic disease over a 20-year period among the young aged 1-35 years in Denmark, assessing incidence, risk factors and potential early detection opportunities. Method This retrospective study utilized data from Danish national registers, including death certificates, hospital records, emergency room registrations, and autopsy reports. Diagnoses, comorbidities, prescriptions, and familial relationships were extracted from the Danish Patient Register, Death Register, National Prescription Registry, and Medical Birth Registry. The study included individuals aged 1 to 35 years in Denmark between 2000 and 2019. Each deceased case was in a separate analysis later matched to five controls based on sex, age, and index date (the case’s date of death). Results During a 53.5-million person-year follow-up, 907 SCD cases were recorded. Of 49 aortic disease-related deaths, 39 were classified as SCD. SCD cases due to aortic disease had a higher prevalence of hypertension. Notably, 16% had a first-degree relative posthumously diagnosed with a connective tissue disorder, suggesting a hereditary component, compared to other cases of SCD. The crude incidence rate (IR) of SCD was 1.74 per 100,000 person-years, while SCD due to aortic disease occurred at 0.07 per 100,000 person-years. While SCD has shown a decreasing trend over time with causes such as SADS following the same trend, the same rate of decline is not observed in aortic death cases (figure.1). Furthermore, ,64% of aortic death cases had visited their general practitioner within one month before the index date,(date of death), and had more frequent medical visits in the 12 months preceding death compared to age-and sex matched controls with co-morbidities such as heart failure, COPD, diabetes and hypertension(figure 2). Conclusion Over a 20-year period in Denmark, the decline in SCD due to aortic disease, in the young, was not as pronounced as in SCD overall or SADS. 76% of all Aortic disease-related deaths in the young, were SCD. 20 % of the cases had a first-degree relative diagnosed with a connective tissue disorder, indicating a potential genetic link. Additionally, frequent healthcare visits before death suggest possible early warning signs, highlighting opportunities for earlier detection and intervention.Figure 1. Figure 2.