Characteristics of cardiovascular deaths in forensic medical cases in Budapest, Vilnius and Tallinn

doi:10.1016/j.jflm.2013.06.011

Journal of Forensic and Legal Medicine

Volume 20, Issue 8, November 2013, Pages 968-971

https://doi.org/10.1016/j.jflm.2013.06.011 Get rights and content

Abstract

Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardiovascular death is essential for the determination of the cause of death. The main purpose of this study is to investigate sudden unexpected cardiovascular death and to study how different geographical climatic influences may affect cardiac mortality in three capitals: Budapest, Vilnius and Tallinn. There were 8482 (5753 male, 2729 female) cardiovascular deaths between 2005 and 2009. The highest rate was observed in the age group between 71 and 80 years (35.17%) and 51–60 years (24.45%). The highest number of cardiovascular deaths occur in January (805/9.49%) and December (770/9.07%). Seasonal distribution was observed, with winter prevalence in Tallinn (279/3.20%) and spring prevalence in Vilnius (760/8.90%). Though in Vilnius and Budapest a great number of deaths occurred in winter and spring, any correlation with other factors (e.g. age, gender, BAC) was not statistically significant. Based on our results we can conclude that environmental–geographical parameters may affect natural cardiovascular death. Examination of pathological patterns and predisposing environmental parameters may help to improve prevention strategies.

Introduction

Cardiovascular diseases are the leading cause of mortality worldwide. Well-known risk factors include hypertension, smoking, diabetes, and hyperlipidaemia that elicit atherosclerosis, a common background to the development of ischaemic heart disease and peripheral arterial occlusions.¹ Several studies have demonstrated that cardiovascular mortality has a characteristic seasonal distribution,² and the inverse relationship between average daily temperatures and ischaemic heart disease mortality has also been shown.3, 4 Cold temperatures may be important triggering factors in the onset of life threatening cardiac events even in countries with relatively mild winters,⁵ however, only few studies have examined the environmental differences between countries with different climate and geography.6, 7

Examination of the pathomorphological characteristics of natural sudden cardiovascular death cases is essential for the determination of the cause of death. Examination of pathological patterns and predisposing environmental parameters may help to improve the prevention strategies. The main purpose of this study was to investigate sudden unexpected cardiovascular death and to study how different geographical climatic influences may affect cardiac mortality in three capitals: Budapest, Vilnius and Tallinn.

Section snippets

Mortality data

In our study we collected cardiovascular death cases autopsied at the Forensic Departments of National Forensic Institutes in three capitals (Budapest, Vilnius and Tallinn) from the period of 2005–2009. The rate of cardiovascular mortality was 36.50% (Budapest: 4765 deaths), 18.30% (Vilnius: 2716 deaths) and 19.20% (Tallinn: 1001 deaths) among medico-legal autopsy cases. During these years the death rate (per 100,000 inhabitants) decreased in all three countries: in Hungary from 702.46 (in

Results

In our material there were 8482 (5753 male and 2729 female) cardiovascular deaths between the years 2005 and 2009 in Budapest, Vilnius and Tallinn. The mean age was 64.07 ± 14.33 year. Male predominance was observed in all the three capitals (Table 1), and 59.83% (5075) of cases involved males over the age of 60. Table 2 demonstrates the distribution of cardiovascular deaths in different age groups. The highest rate was observed in the age group of 71–80 years (35.17%) and 51–60 years (24.45%).

Cardiovascular mortality

The survey target groups included victims of cardiovascular deaths during 2005–2009. We confirmed study results which showed that the most frequent cause of sudden death among adults is ischaemic heart disease.8, 9, 10, 11 International investigations found that about 20% of total mortality originated from cardiovascular diseases. Risk factors like smoking, high body weight, high blood pressure and high cholesterol level could cause ischaemic heart disease,2, 12, 13 and a great number of other

Ethical approval

None.

Funding

None.

Conflict of interest

None.

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Cited by (3)

Love Death—A Retrospective and Prospective Follow-Up Mortality Study Over 45 Years
2017, Journal of Sexual Medicine
Citation Excerpt :
Seasonal influences on the frequency of sexual activities can be considered (eg, “spring fever”). However, it has to be taken in account that the present sample of 99 cases of death connected with sexual activity compared with the sample of 7,450 forensic autopsy cases with unspecific backgrounds examined by Töro et al32,33 is rather small. The data of the present study have been carefully controlled and are of high quality.
Although sexual activity can cause moderate stress, it can cause natural death in individuals with pre-existing illness. The aim of this study was to identify additional pre-existing health problems, sexual practices, and potential circumstances that may trigger fatal events.
This medicolegal postmortem, retrospective, and prospective study is based on data of autopsies performed at the Institute of Legal Medicine of the University hospital, Goethe-University, Frankfurt/Main, Germany.
Identification of pre-existing health problems, sexual practices, and potential circumstances than could trigger fatal events.
From 1972 to 2016 (45 years) approximately 38,000 medicolegal autopsies were performed, of which 99 cases of natural death were connected to sexual activities (0.26%). Except for eight women, men represented most cases. The women’s mean age was 45 years (median = 45) and the men’s mean age was 57.2 years (median = 57). Causes of death were coronary heart disease (n = 28), myocardial infarction (n = 21) and reinfarction (n = 17), cerebral hemorrhage (n = 12), rupture of aortic aneurysms (n = 8), cardiomyopathy (n = 8), acute heart failure (n = 2), sudden cardiac arrest (n = 1), myocarditis (n = 1), and a combination of post myocardial infarction and cocaine intoxication (n = 1). Most cases showed increased heart weights and body mass indices. Death occurred mainly during the summer and spring and in the home of the deceased. If sexual partners were identified, 34 men died during or after sexual contact with a female prostitute, two cases at least two female prostitutes. Nine men died during or after sexual intercourse with their wife, in seven cases the sexual partner was a mistress, and in four cases the life partner. Five men died during homosexual contacts. Based on the situation 30 men were found in, death occurred during masturbation. Of the women, five died during intercourse with the life partner, two died during intercourse with a lover or friend, and in one case no information was provided.
Natural deaths connected with sexual activity appear to be associated with male sex and pre-existing cardiovascular disorders. Most cases recorded occurred with mistresses, prostitutes, or during masturbation. If death occurs, the spouse or life partner might need psychological support.
To our knowledge, the present study contains the largest collection of postmortem data on natural deaths connected with sexual activities. However, the cases presented were of forensic interest; a larger number of undetected cases especially in the marital or stable relationship sector must be assumed.
Patients should be informed about the circumstances that could trigger the “love death.”
Lange L, Zedler B, Verhoff MA, Parzeller M. Love Death—A Retrospective and Prospective Follow-Up Mortality Study Over 45 Years. J Sex Med 2017;14:1226–1231.
A retrospective mortality analysis of natural deaths of the 65+ generation based on postmortem autopsies performed at the Institute of Legal Medicine in Frankfurt am Main during two periods
2021, Rechtsmedizin
Seasonal variations in cardiovascular disease
2017, Nature Reviews Cardiology

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Original communicationCharacteristics of cardiovascular deaths in forensic medical cases in Budapest, Vilnius and Tallinn

Abstract

Introduction

Section snippets

Mortality data

Results

Cardiovascular mortality

Ethical approval

Funding

Conflict of interest

Environ Res

Lancet

Aust N Z J Public Health

Prog Cardiovasc Dis

Environ Res

Public Health

J Forensic Leg Med

Rev Epidemiol Sante Publique

J Card Fail

Vascul Pharmacol

Int J Cardiol

Smoking and hypertension: effects on clinical, biochemical and pathological variables due to isolated or combined action on cardiovascular system

Curr Pharm Des

Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24061 consecutive cases

Eur Heart J

Cold climate and coronary mortality in Sweden

Int J Circumpolar Health

International study of temperature, heat and urban mortality: the ‘ISOTHURM’ project

Int J Epidemiol

Original communication
Characteristics of cardiovascular deaths in forensic medical cases in Budapest, Vilnius and Tallinn