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Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death



Sudden death is a public health problem with major impact on society. Coronary artery disease (CAD) is believed to underlie 60–80% of these deaths. While deaths from CAD have decreased in the recent decades, sudden death rates remain unacceptably high.


We aimed to assess the prevalence of CAD and its risk factors among 18–64-year-old adults in a population-based case registry of sudden deaths and compare them to a living population from the same geographical area.


From 2013 to 2015, all sudden deaths among 18–64-year-old adults in Wake County, NC, were identified (n = 371). A comparison group was formed by randomly selecting individuals from an electronic health record repository of a major healthcare system in the area (N = 4218).

Main Measures

Prevalence of CAD and its risk factors among cases of sudden death and living population across sex and age groups. Odds of sudden death associated with atherosclerotic risk factors and comorbidities.

Key Results

CAD was present in 14.8% of sudden death cases. Among sudden death victims, most risk factors and comorbidities were more common in the older age group, except for obesity which was more common in younger cases, and diabetes which was equally prevalent in younger and older cases. Compared to living population, sudden death cases had higher prevalence of atherosclerotic risk factors across all gender and age groups. Sudden death cases had a numerically higher number of risk factors compared to living population, regardless of age group or presence of CAD.


Coronary artery disease is not common among sudden death cases, but risk factors and comorbidities are prevalent. Our findings support the changing etiology of sudden death. In the absence of clinically diagnosed CAD, use of novel imaging modalities and biomarkers may identify high-risk individuals and lead to prevention of sudden death.

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The Wake County EMS Data System supports, maintains, and monitors EMS service delivery, patient care, and disaster preparedness for the Wake County, NC, community at large. This manuscript has been reviewed by Wake County EMS Data System investigators for scientific content and consistency of data interpretation with previous Wake County EMS Data System publications.

We would like to thank the North Carolina Office of the Chief Medical Examiner, SUDDEN team of researchers, and the Carolina Data Warehouse/North Carolina Translational and Clinical Sciences Institute at University of North Carolina at Chapel Hill.


The SUDDEN project is funded by individual, private donations, The Heart and Vascular Division of the University of North Carolina at Chapel Hill, and the McAllister Heart Institute. The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR002489. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Correspondence to Ross J. Simpson Jr MD, PhD.

Ethics declarations

Compliance with Ethical Standards

This project was reviewed by the University of North Carolina’s institutional review board and found to be exempt (study #: 13-2445).

Conflict of Interest

Ross J. Simpson Jr has served as consultant for Amgen, Merck, Pfizer. CEROBS and ISS. All remaining authors declare that they do not have a conflict of interest.

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Prior presentations: Preliminary results of this analysis were presented as an abstract at European Society of Cardiology (ESC) 2016 meeting, Rome, Italy, August 27–31, 2016.

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Joodi, G., Maradey, J.A., Bogle, B. et al. Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death. J GEN INTERN MED 35, 531–537 (2020).

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  • coronary artery disease
  • sudden death
  • cardiovascular risk factor