Abstract 15918: Race-specific Risk Factors for Sudden Cardiac Death

Introduction: Incidence of sudden cardiac death (SCD) is higher among blacks compared to whites, and occurs at a significantly younger age. Black SCD cases are also more likely than white SCD cases to have prevalent diabetes, hypertension, chronic renal insufficiency, heart failure, left ventricular hypertrophy (LVH), and prolonged ventricular repolarization (QTc), which are established SCD risk predictors among whites. The role of these risk predictors among non-whites is unclear. Hypothesis: We hypothesized that the association between these clinical risk predictors and SCD may vary by race. Methods: This analysis included cases of sudden cardiac arrest and controls from a large community-based study in the Pacific Northwest from 2002 - 2015 who were age ≥18 and white or black, with physician records available prior to arrest. Pre-arrest medical charts were used to obtain medical history. We used age-adjusted logistic regression models including each predictor, race, and a race*predictor interaction term. An interaction p-value of Results: Among 2325 cases, 196 (8.4%) were black; among 995 control subjects, 29 (2.9%) were black. In age-adjusted models, potentially significant interaction with race was observed for diabetes (p=0.06) and heart failure (p=0.14). Stratified results showed diabetes was a stronger risk factor for SCD among blacks (OR 3.7, 95% CI 1.5 - 9.2) than among whites (OR 1.5, 95% CI 1.2 - 1.7). Conversely, among blacks heart failure was less strongly associated with SCD (OR 1.8, 95% CI 0.8 - 4.3) than among whites (OR 3.5, 95% CI 2.8 - 4.3). No significant interaction by race was observed for hypertension, chronic renal insufficiency, LVH, or QTc (p>0.21). Conclusions: The association of diabetes and heart failure with SCD may differ by race. Diabetes appeared to be a stronger predictor of SCD among blacks than among whites, while heart failure was less strongly predictive of SCD among blacks. These data may point toward race-specific mechanisms of SCD, as well as inform strategies for identifying and treating high-risk patients.