Clinicopathological study of the heart and coronary arteries of autopsied cases from the community of Hisayama during a 10 yr period--I. Ischemic myocardial lesions

Temporal trends in sudden unexpected death in a general population: the Hisayama study

BACKGROUND

Studies addressing the temporal trends in the prevalence of sudden unexpected death (SUD) and its underlying causes in the general population are limited.

METHODS

Among a total of 1934 residents aged ≥20 years of the town of Hisayama, Japan, who died of endogenous causes of death and underwent autopsy examination (autopsy rate 78.5%) from 1962 to 2009, 204 were determined to be cases of SUD within 24 hours.

RESULTS

The trend in the age- and sex-adjusted prevalence of SUD among all autopsy subjects was stable over four 12-year periods (13.1% in 1962-1973, 13.4% in 1974-1985, 15.0% in 1986-1997, and 14.6% in 1998-2009; P for trend = .80). Regarding causes of death, the prevalence of SUD from stroke significantly declined with time (8.0%, 5.0%, 2.3%, and 2.1%, respectively; P for trend < .001), whereas significant increments were observed in the prevalence of SUD from heart disease (4.0%, 6.2%, 8.6%, and 9.7%; P for trend = .02) and from aortic aneurysm and dissection (0.2%, 1.2%, 2.9%, and 2.8%; P for trend = .01). In particular, the prevalence of ischemic heart disease increased 3-fold from 2.1% in 1962-1973 to 6.6% in 1998-2009 (P = .04). Reflecting the increment of ischemic heart disease, SUD within 1 hour increased significantly from 2.5% to 7.6% during this period (P = .01).

CONCLUSIONS

The trend in the prevalence of SUD was stable across a half century in a general Japanese population. Despite the decrement in the prevalence of SUD from stroke, that from heart disease, especially ischemic heart disease, increased significantly with time.

Review of the validity of national coronary heart disease mortality rates

Epidemiologic studies of coronary heart disease are heavily dependent on national mortality rates. The diagnostic error for the coronary heart disease is substantial but unquantifiable and is conservatively at least +/- 30%. When this error is superimposed on innumerable errors and omissions in the compilation of monocausal mortality rates, the reliability of such vital statistics currently precludes their use for scientific purposes.

Clinicopathological study of the heart and coronary arteries of autopsied cases from the community of Hisayama during a 10-year period. Part IV. QS waves in the precordial leads

During a ten-year period, from November 1, 1961, to October 31, 1971, 339 residents aged 40 years or over at death were nonselectively autopsied in a Japanese community, Hisayama town (mean autopsy rate: 84%). One or more standard 12-lead ECGs plus V4R and V7 electrocardiograms taken at periodic medical examinations were available for 308 of them. In 46 persons, QS waves were localized in one or more leads from V1 to V4. By transverse sectioning of the hearts, old myocardial infarction extending into the interventricular septum was found in nine of these 46 persons. Frequency of myocardial infarction cases in each category for QS localization was as follows: Lead V1 to V4, three of three; Leads V1 to V3, six of nine; Leads V1 and V2, three of 15; Leads V2 and V3, none of two; Lead V3, none of one; Lead V2, one of eight; and Lead V1, one of 25.