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This study examined sex differences in sudden cardiac arrest (SCA) patients across two communities, analyzing clinical conditions, electrocardiographic, and echocardiographic characteristics. Women with SCA showed distinct patterns compared to men, including higher rates of thyroid disease, asthma, mood disorders, and left ventricular hypertrophy, but lower rates of coronary artery disease and reduced heart function. Notably, these sex-specific patterns in SCA cases were opposite to those observed in the general community population from the Framingham Heart Study, suggesting that traditional risk factors may not adequately predict SCA risk in women.
Why it matters
Current SCA risk prediction models underperform in women, potentially leading to missed prevention opportunities. Identifying sex-specific risk patterns could enable development of tailored screening tools and preventive strategies that better identify women at high risk for sudden cardiac arrest, ultimately reducing mortality disparities.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background: Sex differences in sudden cardiac arrest (SCA) incidence and outcomes are well established, but risk stratification underperforms in women. It is important to delineate sex-specific patterns in SCA across clinical, electrocardiographic, and echocardiographic domains. Methods: We studied out-of-hospital SCA cases from the Oregon Sudden Unexpected Death Study (ORSUDS; Portland, 2002-2020; discovery) and Prediction of Sudden Death in Multi-Ethnic Communities (PRESTO; Ventura County, 2015-2024; external replication). Sex differences in 38 comorbidities, 19 ECG and 12 echocardiographic measures were estimated using multivariable-adjusted logistic regression. Female sex was the modeled dependent measure (male as reference). ORSUDS estimates were compared with those in the Framingham Heart Study (FHS), a community-based reference cohort, using FDR-adjusted Cochran Q tests. Results: Among 5130 ORSUDS cases, 1715 (33.4%) were women (median age, 70.4 years [IQR, 58.7-81.8]) and 3415 (66.6%) were men (65.6 [55.0-76.8]). Compared with men, women had higher BMI (per 5 kg/m2, 1.11 [1.08-1.15]) and higher odds of thyroid disease (2.56 [2.17-3.13]), asthma (2.33 [1.92-2.86]), mood disorder (2.17 [1.85-2.50]), dementia (1.27 [1.02-1.56]), and left ventricular hypertrophy (LVH, 3.13 [2.44-4.00]). Women also had lower odds of coronary artery disease (0.61 [0.52-0.71]), atrial fibrillation (0.67 [0.56-0.79]), prolonged QTc (0.45 [0.35-0.57]), prolonged PR (0.53 [0.41-0.68]), premature contractions (0.77 [0.60-0.98]), sleep apnea (0.53 [0.43-0.65]), and reduced LVEF (0.40 [0.29-0.54]). Most findings were replicated in PRESTO (n=2719). In contrast, several of these differences were reversed in the community (FHS, n=3539;FDR-significant): prolonged QTc was more common in women, whereas LVH, dementia, heart failure, and higher BMI were more common in men. Conclusions: Sex differences among SCA cases were mostly reproducible in SCA cohorts, and distinct from sex-related patterns in the community. These results have implications for development of sex-specific SCA risk assessment and prevention strategies.