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Increased risk of sudden death in untreated primary carnitine deficiency
Author(s) -
Rasmussen Jan,
Dunø Morten,
Lund Allan M.,
Steuerwald Ulrike,
Hansen SteenHolger,
Joensen Høgni D.,
Køber Lars,
Nielsen Olav W.
Publication year - 2020
Publication title -
journal of inherited metabolic disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 102
eISSN - 1573-2665
pISSN - 0141-8955
DOI - 10.1002/jimd.12158
Subject(s) - sudden death , medicine , sudden cardiac death , cause of death , odds ratio , population , cardiomyopathy , heart failure , disease , environmental health
Primary carnitine deficiency (PCD) affects fatty acid oxidation and is associated with cardiomyopathy and cardiac arrhythmia, but the risk of sudden death in PCD is unknown. The Faroe Islands have a high prevalence of PCD, 1:300. This study systematically investigated a possible association between untreated PCD and sudden death in young Faroese subjects. We investigated all medico‐legal cases of sudden death between 1979 and 2012 among subjects below the age of 45. Stored biomaterial was examined with molecular genetic analysis to reveal PCD. We compared the prevalence of PCD among sudden death cases with that of the background population (0.23%) to calculate the odds ratio (OR) for sudden death with PCD. Biomaterial was available and genetically analyzed from 53 of 65 sudden death cases (82%) in the Faroe Islands. Six (one male and five females) of the 53 cases were homozygous for the PCD related c.95A>G mutation—a prevalence of 11.3% (95% CI 5%‐23%) and an OR of 54.3 (95% CI 21‐138, P < .0001) for the association between sudden death and untreated PCD. Only 11 of the 53 sudden death cases were women—of whom five were homozygous for the c.95A>G mutation (45.5%) yielding an OR of 348.8 (95% CI 94‐1287, P < .0001) for the association between sudden death and untreated PCD in females. This study showed a strong association between sudden death and untreated PCD, especially in females.