Abstract 9188: Sex Differences in Cardiovascular Risk and Guideline-Based Preventive Medication Use Among Sudden Death Victims

Abstract

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is associated with an increased risk of sudden death. Preventive medications are recommended by clinical practice guidelines for those with elevated ASCVD risk. Guidelines are often underutilized and use of preventive medications differs by sex. Methods: Out-of-hospital deaths of adults aged 18-64 were reported by emergency medical services in Wake County, North Carolina from 2013-2015 and underwent adjudication to identify sudden unexpected death cases. A cohort of 1,114 living controls was generated through random sampling from a central electronic health records repository and propensity scores matched to the sudden death victims based on sex and race. A 10-year ASCVD risk was calculated for all subjects with the requisite components and categorized as low (<7.5%), intermediate (7.5%-19.9%), and high (≥20%). Use of preventive medications, specifically aspirin and statin, was assessed. Logistic regression models were fitted to evaluate the association between 10-year ASCVD risk and sudden death both overall and by sex. Odds ratios for males and females were compared in a pairwise fashion using an adjusted Wald test. Results: The average 10-year ASCVD risk was higher among sudden death victims compared to living controls for both males (36.4 ± 22.2 vs. 16.3 ± 16.0, p-value <0.001) and females (20.6 ± 17.9 vs. 7.1 ± 8.4, p-value <0.001). Among intermediate or high 10-year ASCVD risk sudden death victims and controls, aspirin and statin use were low (13-21%). Among those with intermediate or high ASCVD risk, male sudden death victims were less likely than living controls to be prescribed aspirin (p-value 0.007). Comparing sudden death victims to living controls, there was no difference in statin use among males or in aspirin or statin use among females. There was no significant difference in the strength of association between 10-year ASCVD risk categories and sudden death by sex. Conclusions: Although the average 10-year ASCVD risk of sudden death victims is higher than living controls both overall and by sex, the use of aspirin and statin was low and did not differ significantly between victims and controls. Improvements are needed to increase the use of guideline-based preventive medications.