#3 | December 2023
Dilated cardiomyopathy
The American Heart Association (AHA) defines cardiomyopathy as “a heterogeneous group of diseases of the myocardium, usually with inappropriate ventricular hypertrophy or dilatation” [1]. Cardiomyopathies may be primary (i.e., genetic, mixed, or acquired) or secondary (e.g., infiltrative, toxic, inflammatory). [2]
Table 1: Distribution of types of cardiomyopathies [3]
Ranthe, M.F. et al Risk of Cardiomyopathy in young persons with a FH of death of CM, Circulation. 2015;132:1013-1019
Overall annual new incidence of all cardiomyopathies is approximately 7-10 per 100,000 p.a. Dilated cardiomyopathy (DCM) is the most common subtype of this cardiac disease (see table 1), and causes one third of all new annual incidence (5-7 per 100,000) [3]. It is a major cause of heart failure and those with DCM constitute the largest group of patients undergoing heart transplant. It is estimated to affect 1 in 500 individuals in the developed countries.
There is a male preponderance (64%) and most cases manifest after age 50. Young age onset is highly indicative of familial trait and disease phenotype. [4]
Approximately one third of cases have a genetic (usually autosomal dominant inheritance pattern) cause with over 12 different phenotypes currently identified.
Figure 1: Age and gender distribution of DCM [4]
UK Hospital Episode Statistics, NHS Digital, accessed 1 February 2019, contains information from NHS England, licenced under the current version of the Open Government Licence
Mortality considerations
Mortality remains significant, but with new therapies aimed at ‘reverse remodelling’ as well as increased use of ICDs (implantable cardioverter defibrillator), death rates have hugely improved in the last decade, especially in certain cohorts. This means that, for some lives, life insurance terms can now be considered albeit with heavy extra premium.
Author
Paul Edwards
Underwriting Research & Systems Development Manager
Hannover Re UK Life Branch
References
- Maron BJ et al. American Heart Association; Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; Council on Epidemiology and Prevention. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006 Apr 11;113(14):1807-16. doi: 10.1161/CIRCULATIONAHA.106.174287. Epub 2006 Mar 27. PMID: 16567565.
- Elton, T et al. Cardiomyopathy: an overview American Family Physician May 1, 2009 Volume 79, Number 9
- Ranthe, M.F. et al. Risk of Cardiomyopathy in young persons with a FH of death of CM, Circulation. 2015;132:1013-1019
- UK Hospital Episode Statistics; NHS Digital under: https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics; accessed 1 February 2019; contains information from NHS England, licenced under the current version of the Open Government Licence
Images: tashatuvango/stock.adobe.com; Pijitra/stock.adobe.com
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