Thermogenic Supplement Use Does Not Alter Characteristics of Sudden Death in the Young

• Published in: Pacing and clinical electrophysiology Vol. 35; no. 11; pp. 1332 - 1337
• Main Authors: APPEL, DAVID A., MCNEAR, JENNIFER A., SHRY, ERIC A., GENTLESK, PHILIP J., REICH, STEPHEN S., ECKART, ROBERT E.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.11.2012; Wiley
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; arrhythmias; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Coronary Artery Disease - mortality; Death, Sudden, Cardiac - epidemiology; Dietary Supplements - utilization; Drug-Related Side Effects and Adverse Reactions - mortality; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Heart; Humans; Incidence; Intensive care medicine; Male; Medical sciences; Military Personnel - statistics & numerical data; Plant Extracts - therapeutic use; Registries; Risk Factors; sudden cardiac death; supplements; Survival Analysis; Survival Rate; United States - epidemiology; United States; supplements; Cardiocirculatory arrest; Arrhythmia; arrhythmias; Heart disease; Sudden death; Cardiovascular disease; sudden cardiac death
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2012.03510.x

Background: To evaluate supplement use, most notably ephedra, which has been temporally associated with sudden death. Animal models suggest increased myocardial irritability may predispose to primary arrhythmic death. Methods: Clinical, pathological, and investigative records from the Office of the Armed Forces Medical Examiner's Cardiovascular Death Registry were reviewed. Forty‐eight cases of those with known supplement use were compared to 144 age‐, gender‐, and socioeconomic‐matched controls in a 1:3 case:control manner. Results: Of the 48 sudden deaths temporally associated with supplement use, the mean age was 34.2 ± 10.0 years and predominantly male (n = 44, 91.7%). The underlying cause of death was fatal atherosclerotic coronary disease in 18 (37.5%), sudden unexplained death in 16 (33.3%), and hypertrophic cardiomyopathy in six (12.5%). Compared with controls, there were no statistically significant differences in adjudicated cause of death. On autopsy, there were no differences in cardiac mass, ventricular wall thickness, or presence of atherosclerosis in those known to be taking identified supplements compared to a control population. In the subject ≥35 years, and known to be taking supplements, there was a significant increase in causality of death as due to sudden unexplained death (relative risk = 5.1 [95% confidence interval, 1.4–18.7]). Conclusions: Active surveillance of mortality in an autopsy‐derived series of young adults finds atherosclerotic coronary disease and idiopathic sudden death are common etiologies of death when taking supplements, but no cardiac structural or histologic mechanism to suggest different pathologic process than a matched control population. (PACE 2012; 35:1332–1337)