Abstract

Aims: Obesity is a rising public health problem and widely known risk factor for cardiovascular diseases. The aim of the study was to determine the main features and aetiologies in a large cohort of sudden cardiac deaths (SCD) occurred in obese subjects Methods: Between 1994 and 2014, 3684 consecutive cases of unexpected SCD were referred to our cardiac pathology centre. This study was confined to young individuals (age ≤ 35 years) where information about body mass index (BMI) was available and comprised of 1033 cases. Results: Four hundred ninety-one patients (25%) were obese. In obese SCD victims the main post-mortem findings were: normal heart (sudden arrhythmic death syndrome, SADS) (n=192, 39%), unexplained left ventricular hypertrophy (LVH) (n=88, 18%) and critical coronary artery disease (CAD) (n=57, 12%). Less common were hypertrophic cardiomyopathy (HCM) (n=24, 4%) and arrhythmogenic right ventricular cardiomyopathy (ARVC) (n=22, 4%). When compared with non-obese SCD victims, SADS was less common (39 vs 51%, p<0.001) whereas LVH and critical CAD were more frequent (18 vs 3%, p<0.001 and 12 vs 6%, p<0.001 respectively). The prevalence of critical and non-critical CAD was significantly higher in obese individuals (23 vs 10% in non-obese, p<0.001). Conclusions: Various conditions underlie SCD in obesity, with a prevalence of SADS, LVH and CAD. The degree of LVH measured by heart weight is excessive even after correction for body size. Almost one in four young obese sudden death victims show some degree of CAD, underscoring the need for primary prevention in this particular subgroup.