Trends from 1987 to 2004 in sadden death due to coronary heart disease: The Atherosclerosis Risk in Communities (ARIC) study

Background Few data are available on the secular changes in sudden coronary heart disease (CHID) death in US communities. Methods We examined trends in sudden CHID death from 1987 to 2004, using data from the Atherosclerosis Risk in Communities (ARIC) study. Sudden CHID deaths in residents of 4 communities aged 35 to 74 years were ascertained using multiple sources such as death certificates, informant and coroner interviews, and physician adjudications. Poisson regression was used to assess the trends for the 6 periods: 1987 to 1989, 1990 to 1992, 1993 to 1995, 1996 to 1998, 1999 to 2001, 2002 to 2004, after adjusting for demographic factors. Results Overall, 32.6% of CHID deaths were sudden, occurring within an hour after the onset of symptoms, 63.5% of which had no prior diagnosis of CHID. For women, the rate declined by 40% (P = .059) for sudden deaths with CHID history, 27% (P = .067) for those without CHID history, and 39% (P < .001) for nonsudden CHID deaths. The trends did not differ by community. For men, the trends differed by community for sudden deaths with and without CHID history (Ps for the interaction = .019 and .009, respectively) but not for nonsudden CHID death (P for the interaction = .10). For all communities combined, the decline in men was greatest for sudden deaths with CHID history (by 58%, P < .001), followed by nonsudden CHID deaths (by 39%, P < .001) and sudden deaths without CHID history (by 31%, P = .002). However, the proportion of CHID deaths that were sudden had remained stable over time. Conclusion Although the rate of sudden CHID deaths, with and without CHD history, declined overtime, the trend pattern may differ by community and gender. (Am Heart J 2009;157:46-52.)