Sudden Unexpected Death in Young Adults Often Due to Natural Causes
Sudden Unexpected Death in Young Adults Often Due to Natural Causes
October 23, 2007 (New Orleans) — Sudden unexpected death among young adults is often blamed on cocaine or methadone abuse, but a new study shows that more than half of these deaths are the result of natural causes.
"Many of the deaths in younger people are assumed to be drug-related — especially when there is a history of drug use and an autopsy is not performed," Zhaohai Yang, MD, a resident in the Department of Pathology, University of Alabama at Birmingham, reported at a poster session here at the American Society for Clinical Pathology (ASCP) 2007 Annual Meeting.
"The study was conducted to understand the causes of sudden unexplained death among young adults, and we found that at least half were not drug related," Dr. Yang told Medscape Pathology.
The 3-year autopsy case study identified anatomic causes of death in young individuals (aged ≤40 years) without known significant medical disease who suffered unexpected, nontraumatic sudden death.
According to the National Vital Statistic Reports published in March 2007, accident is the leading cause of death in individuals aged 15 to 44 years, accounting for 19% to 49% of total deaths, the researchers reported. Of 781 cases reviewed in this series, 22 cases (17 men and 5 women aged 14 – 40 years) fit the study criteria.
Of the 22 cases, 45% died of drug intoxication, and 55% died of natural causes. Although coronary artery disease accounted for 27% of heart-related deaths, congenital cardiac anomalies, disease involving the conduction system, and mild structural cardiac abnormalities were the major findings in 73% of the heart-related deaths.
Ten deaths (45%) in the series had a positive drug screen for illegal drugs, and drug toxicity was considered to be the major cause of death. Anatomic causes were identified in the remaining 12 cases (55%).
Heart disease was the number one cause of death, accounting for 11 deaths (50%). There were 3 coronary artery disease/acute myocardial infarction deaths, 5 myocardial fibrosis/cardiomegaly with presumed arrhythmia deaths, 1 cardiomyopathy death (systemic sarcoidosis with extensive involvement of the heart), and 2 congenital heart disease deaths (1 death from bicuspid aortic valve and absence of left circumflex coronary artery, and 1 from dysplasia of the atrioventricular nodal artery).
One person died of a pulmonary thromboembolism.
"Of note, a positive drug history was reported in 8 cases; 6 of these individuals died of drug intoxication, but 2 had negative drug screens and died of natural causes," Dr. Yang and senior author Stephanie D. Reilly, MD, also from the Univerity of Alabama, write in their abstract. "Even in patients with a drug abuse history, a significant portion of cases had an unsuspected medical condition as the cause of death."
In addition, 4 patients who had a negative drug history had a drug-related death.
"This means that a negative drug history does not exclude drug toxicity as a possible cause of death," Dr. Reilly, told Medscape Pathology.
"Among the drugs detected, cocaine and diazepam are well-known to have cardiac toxicity, while methadone affects the QTc interval," the researchers note in the poster. "Mild heart abnormalities were detected in those who died of drug abuse; however, whether they had an additive effect is unknown."
ASCP President Lee Hilborne, MD, professor of pathology and laboratory medicine at the David Geffen School of Medicine at the University of California, Los Angeles, said in an interview with Medscape Pathology that "One of the values of the autopsy is that it can identify cause of death and reveal medical findings that may not have been appreciated in the person's life and may help the families."
Even though slightly more than half of the deaths were the result of undetected medical problems, he said,"the rest were drug-related — you can't ignore that these drugs had direct adverse consequences."
The study did not receive external funding. The authors and Dr. Hilborne have disclosed no relevant financial relationships.
American Society for Clinical Pathology 2007 Annual Meeting: Abstract 88. Presented October 20, 2007.
October 23, 2007 (New Orleans) — Sudden unexpected death among young adults is often blamed on cocaine or methadone abuse, but a new study shows that more than half of these deaths are the result of natural causes.
"Many of the deaths in younger people are assumed to be drug-related — especially when there is a history of drug use and an autopsy is not performed," Zhaohai Yang, MD, a resident in the Department of Pathology, University of Alabama at Birmingham, reported at a poster session here at the American Society for Clinical Pathology (ASCP) 2007 Annual Meeting.
"The study was conducted to understand the causes of sudden unexplained death among young adults, and we found that at least half were not drug related," Dr. Yang told Medscape Pathology.
The 3-year autopsy case study identified anatomic causes of death in young individuals (aged ≤40 years) without known significant medical disease who suffered unexpected, nontraumatic sudden death.
According to the National Vital Statistic Reports published in March 2007, accident is the leading cause of death in individuals aged 15 to 44 years, accounting for 19% to 49% of total deaths, the researchers reported. Of 781 cases reviewed in this series, 22 cases (17 men and 5 women aged 14 – 40 years) fit the study criteria.
Of the 22 cases, 45% died of drug intoxication, and 55% died of natural causes. Although coronary artery disease accounted for 27% of heart-related deaths, congenital cardiac anomalies, disease involving the conduction system, and mild structural cardiac abnormalities were the major findings in 73% of the heart-related deaths.
Ten deaths (45%) in the series had a positive drug screen for illegal drugs, and drug toxicity was considered to be the major cause of death. Anatomic causes were identified in the remaining 12 cases (55%).
Heart disease was the number one cause of death, accounting for 11 deaths (50%). There were 3 coronary artery disease/acute myocardial infarction deaths, 5 myocardial fibrosis/cardiomegaly with presumed arrhythmia deaths, 1 cardiomyopathy death (systemic sarcoidosis with extensive involvement of the heart), and 2 congenital heart disease deaths (1 death from bicuspid aortic valve and absence of left circumflex coronary artery, and 1 from dysplasia of the atrioventricular nodal artery).
One person died of a pulmonary thromboembolism.
"Of note, a positive drug history was reported in 8 cases; 6 of these individuals died of drug intoxication, but 2 had negative drug screens and died of natural causes," Dr. Yang and senior author Stephanie D. Reilly, MD, also from the Univerity of Alabama, write in their abstract. "Even in patients with a drug abuse history, a significant portion of cases had an unsuspected medical condition as the cause of death."
In addition, 4 patients who had a negative drug history had a drug-related death.
"This means that a negative drug history does not exclude drug toxicity as a possible cause of death," Dr. Reilly, told Medscape Pathology.
"Among the drugs detected, cocaine and diazepam are well-known to have cardiac toxicity, while methadone affects the QTc interval," the researchers note in the poster. "Mild heart abnormalities were detected in those who died of drug abuse; however, whether they had an additive effect is unknown."
ASCP President Lee Hilborne, MD, professor of pathology and laboratory medicine at the David Geffen School of Medicine at the University of California, Los Angeles, said in an interview with Medscape Pathology that "One of the values of the autopsy is that it can identify cause of death and reveal medical findings that may not have been appreciated in the person's life and may help the families."
Even though slightly more than half of the deaths were the result of undetected medical problems, he said,"the rest were drug-related — you can't ignore that these drugs had direct adverse consequences."
The study did not receive external funding. The authors and Dr. Hilborne have disclosed no relevant financial relationships.
American Society for Clinical Pathology 2007 Annual Meeting: Abstract 88. Presented October 20, 2007.
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