Postmortem Lipid Levels for the Analysis of Risk Factors of Sudden Death

Elevated serum cholesterol, triglyceride, and free fatty acid levels have been identified as risk factors for sudden death from cardiovascular disease and increased risk for myocardial ischemia or arrhythmias; therefore, correlation of antemortem and postmortem lipid levels may be useful in establishing the cause, pathophysiology, or familial risk factors of sudden death. In the present study, antemortem (within 72 h) and postmortem (within 24 h) cholesterol, triglyceride, free fatty acid, and albumin levels were analyzed in seven autopsied hospitalized patients from the University of New Mexico Hospital in Albuquerque, New Mexico. The cholesterol, triglyceride, and albumin levels were measured by dry-slide technology on an Ektachem 700 analyzer, and the free fatty acid levels were measured on a Monarch analyzer with a commercially available kit from Wako Chemical. Postmortem cholesterol levels averaged 13% lower than antemortem levels, postmortem triglyceride levels averaged 38% higher than antemortem levels, postmortem free fatty acid levels averaged 23% lower than antemortem levels, and postmortem albumin levels were essentially unchanged (<0.01% higher) from antemortem levels. Whether the antemortem and postmortem differences in lipid levels were the result of postmortem degradation products, a general phenomenon (such as variable enzyme degradation), or an idiosyncracy of the Ektachem or Monarch systems could not be definitely established. These preliminary results suggest that caution should be exercised when interpreting postmortem cholesterol, triglyceride, and free fatty acid levels analyzed on the Ektachem or Monarch systems.