Sudden adult death is a major problem in both developing and developed countries. We identified 318 cases in 10 years, an annual frequency of 31.8 cases. Mohamed et al [4] had noted 476 cases in 3 years, an average of 158.7 cases /year. Ossei et al [5] found 1,470 cases over 9 years, an average of 163.33 cases /year. The frequencies of the African series are much lower than those of the developed countries. Indeed it is 300 000 cases /year in the United States according to Zheng et al [3]. These low frequencies of the African series could be explained by still negligible demands of autopsies in the event of sudden death, linked to the sacred cultural character of death in our countries and the lack of systematic realization of scientific autopsies in hospitals. We noted a male predominance with 202 cases, a sex ratio (H/F) of 1.8. This observation is consistent with the majority of series where there was a male predominance. Mohamed et al [4] noted a sex ratio (H/F) of 2.97; Ossei et al [5] found a sex ratio (H/F) of 3.1. This male predominance is explained by the higher and earlier incidence of ischemic heart disease in men, a different susceptibility to ischemia, a different distribution of structural heart disease and the protective nature of estrogens [6,7]. The average age of our patients was 43 ± 0.36 years with extremes of 9 years and 75 years. Mohamed et al [4] noted an average age of 45.5 years. In developed countries, sudden death occurs mainly in the elderly with an average age of 68 + 20 years [2,8]. This relatively low average age of African series can be explained by the much lower life expectancy in these developing countries.
Regarding risk factors, we noted obesity in 189 cases (59.4%). with an umbilical adipose panicle varying between 7 and 12 cm thick. The specific association between abdominal obesity and sudden death has been described. In the Paris prospective study, there was a specific risk gradient between the abdominal diameter level and sudden death, while there was no association with death from myocardial infarction [9].
The causes of death were dominated by cardiovascular causes excluding cerebral involvement (n = 173cases, 54.40%) followed by pulmonary causes (n = 100 cases, 31.44%). Cardiovascular causes are the leading cause of sudden death in all series. Mohamed et al [4] noted a predominance of cardiovascular causes with 48.7% of the causes of sudden death, followed by bronchopulmonary causes with 36% of the causes of sudden death. In Western countries, the incidence of sudden cardiac death is 88% of sudden deaths in middle-aged and elderly adults. In these developed countries in general the mortality was related to the complications of atherosclerosis. The prevention of nutritional and metabolic risk factors has reduced this mortality [10]. The most common cardiac pathology was myocardial infarction (n = 102 cases, 58.96%) and accounted for 32.07% of all causes of sudden death, followed by coronary thrombosis, concordant with most reported series in the literature [11, 12]. There has been an increase in sudden cardiac deaths on a regular basis over the entire duration of the study, from 7 cases in 2010, to 17 cases in 2018. This increase is mainly in myocardial infarction, which represented 3 cases in 2010 and 12 cases in 2018, concordant with certain African series [4, 13]. This situation in the developing countries is explained by the urbanization anarchic with emergence of bad habits hygieno-dietary. We eat too much fat, too much sugar, too much salt and we do little physical activity, hence the appearance of cardiovascular risks factors.