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The Helsinki Sudden Death Study (HSDS)

The Helsinki Sudden Death Study (HSDS) was launched to study the lifestyle and genetic factors predisposing to sudden death in Finnish middle-aged men who lived in Helsinki and its surroundings. The HSDS consists of 2 autopsy series collected at 10-year intervals. The first series (A series) was collected during 1981-1982 and the second series (B series) during 1991-1992. The 2 autopsy series included 700 men 33 to 70 years old (mean 53.07 years, SD 9.58 years, median 54 years) subjected to a medico-legal autopsy. Indications for an autopsy were out-of-hospital death of a previously healthy man, accidental death, suspected intoxication, suicide, or death in connection with medical treatment. More than half the men died of disease, 68% of cardiac origin. The second most common causes of death were intoxication and violence, most of these accidental or self-inflicted.
DNA samples were collected from both autopsy series. DNA from older cohort is extracted from paraffin-embedded tissue samples and therefore DNA from this series is more suitable for genotyping only single SNPs.

THL – The National Institute for Health and Welfare, University of Tampere

Principal Investigators:
Pekka Karhunen, firstname.lastname (at) uta.fi
Markus Perola, firstname.lastname (at) thl.fi

Contact person:
Markus Perola, firstname.lastname (at) thl.fi

Key reference:
Birthplace predicts risk for prehospital sudden cardiac death in middle-aged men who migrated to metropolitan area: The Helsinki Sudden Death Study.Tyynela P, Goebeler S, Ilveskoski E, Mikkelsson J, Perola M, Loytonen M, Karhunen PJ. Ann Med. 2009;41(1):57-65

Helsinki Sudden Death Study - Detailed Information:

Background

According to the Section 7 of the Cause of Death Law (459/73) of Finland, a police inquiry must be conducted to determine the cause of death whenever: 1) death is not known to be due to illness, or if the deceased has not been treated by a physician during the period of his/her latest ill­ness; 2) when death is caused or suspected to have been caused by a crime, accident, suicide, poisoning, occupa­tional disease or medical treatment procedure; or, 3) in cases of otherwise unexpected death. This investigation is assisted by a physician and a forensic autopsy is quite rou­tinely performed in such cases to determine the cause of death in the manner required by law. Finnish provincial governments totaling six are responsible for the perfor­mance of forensic autopsies within their districts. As can be assumed from the law, the forensic autopsy rate is quite high in Finland. For example, a forensic autopsy is per­formed in Helsinki area in 42% of all deaths in people less than 65 years old.

Study protocol

The Helsinki Sudden Death Study (HSDS) was launched to study the lifestyle and genetic factors predisposing to sud­den death in Finnish middle-aged men who lived in Hel­sinki and its surroundings. The HSDS consists of 2 autopsy series collected at 10-year intervals. The first series (A se­ries) was collected during 1981–1982 and the second series (B series) during 1991–1992. The 2 autopsy series in­cluded 700 men 33 to 70 years old (mean 53.07 years, SD 9.58 years, median 54 years) subjected to a medico-legal au­topsy. Indications for an autopsy were out-of-hospital death of a previously healthy man, accidental death, sus­pected intoxication, suicide, or death in connection with medical treatment. More than half the men died of disease, 68% of cardiac origin. The second most common causes of death were intoxication and violence, most of these acci­dental or self-inflicted. The study was approved by the Eth­ics Committee of the Department of Forensic Medicine, University of Helsinki.

Questionnaire and interview data

In HSDS a closely associated person, usually a relative was interviewed carefully close to the time of the autopsy. The questionnaire was concentrated to measure deceased’s life style, with special emphasis on cardiovascular risk factors and alcohol use. There is a detailed autopsy report from each autopsy case (HSDS and others) stored in paper form.

Laboratory measurements and reserve sampling

Forensic autopsies are performed as so-called complete au­topsies and may include forensic chemical, microscopic, bacteriologic, virologic, serologic, genetic and asbestos fi­ber determinations, X-ray and other special investigations. In most of the autopsies, histological samples are taken and preserved in paraffin; these tissue samples are preserved indefinitely. In HSDS an even more detailed autopsy was performed, including careful dissection of coronary and aortic arteries, post-mortem angiography and X-rays, and wide-spread sampling of tissues.

Registry links and data handling

Linking autopsy patients to registries is not routinely per­formed (expect for Cancer Registry), but it is possible with appropriate permits. In HSDS data is stored as SAS, SPSS and Excel formats. For other forensic autopsies, causes of death are stored electronically but most of autopsy reports are in paper form.