Sickle cell trait associated with a RR of death of 37 times in national collegiate athletic association football athletes: a database with 2 million athlete-years as the denominator

Abstract

BackgroundThis study examines sickle cell trait (SCT) as a cause of sudden death in National Collegiate Athletic Association (NCAA) athletes and explores the cost-effectiveness of different screening models. Methods The authors reviewed the cause of all cases of sudden death in NCAA student-athletes from January 2004 through December 2008. The authors also explored the cost-effectiveness of screening for this condition in selected populations assuming that identifying athletes with SCT would prevent death. Results There were 273 deaths and a total of 1 969 663 athlete-participant-years. Five (2%) deaths were associated with SCT. In football athletes, there were 72 (26%) deaths. Of these, 52 (72%) were due to trauma unrelated to sports activity and 20 (28%) were due to medical causes; nine deaths were cardiac (45%), fi ve were associated with SCT (25%). Thirteen of the 20 deaths due to medical causes occurred during exertion; cardiac (6, 46%) SCT associated (5, 39%), and heat stroke unrelated to SCT (2, 15%). All deaths associated with SCT occurred in black Division I football athletes. The risk of exertional death in Division I football players with SCT was 1:827 which was 37 times higher than in athletes without SCT. The cost per case identifi ed varied widely depending on the population screened and the price of the screening test. Conclusions Exertional death in athletes with SCT occurs at a higher rate than previously appreciated. More research is needed to (1) understand the pathophysiology of death in SCT-positive athletes and (2) determine whether screening high-risk populations reduces mortality.

Association among sickle cell trait, fitness, and cardiovascular risk factors in CARDIA

“…That we did not find a difference using data from the CARDIA study is particularly important, given the young age of the cohort at the start of the study and the frequent description of exertion-related sudden death in young student athletes with SCT. 7 Data from largescale observational studies, including the National Health and Nutrition Examination Survey and Health, Risk Factors, Exercise Training and Genetics studies, have demonstrated lower fitness, measured directly by maximal tests or estimated from submaximal tests, in African American individuals when compared with their Caucasian counterparts. 36,37 However, it is more likely that lower levels of physical activity and higher BMI, which may affect muscle oxidative potential, contribute to disparities in fitness between African Americans and Caucasians.…”

“…[7][8][9] Growing evidence suggests SCT carriers may exhibit abnormal physiologic responses to cardiopulmonary exercise testing when compared with controls without SCT. [10][11][12][13] More recently, SCT status was also shown to be associated with a significantly higher risk for exertional rhabdomyolysis among black soldiers on active duty in the US Army.…”

“…[1][2][3][4][5][6] Importantly, there is growing concern SCT may be associated with sudden death during strenuous physical activity and exercise, leading to the National College Athletics Association to mandate carrier status testing among all student athletes in division I institutions in 2010, and later in all division II and III institutions. [7][8][9] Growing evidence suggests SCT carriers may exhibit abnormal physiologic responses to cardiopulmonary exercise testing when compared with controls without SCT. [10][11][12][13] More recently, SCT status was also shown to be associated with a significantly higher risk for exertional rhabdomyolysis among black soldiers on active duty in the US Army.…”

Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age)

“…138 Unlike SD attributable to underlying cardiovascular disease and ventricular tachyarrhythmia, sickle cell trait-related collapse probably results from a more gradual deterioration and cascade of events, with intravascular sickling leading to vascular occlusion, endothelial damage, and impaired blood flow to muscles, which can promote ischemic rhabdomyolysis and disseminated intravascular coagulation. 138,169 In 2010, the NCAA mandated sickle cell trait screening (with solubility testing) for all student-athletes in Division I sports. 170 This program was created as part of a legal settlement with Rice University and the NCAA filed by the family of a college football player who died of exertional sickling with rhabdomyolysis at age 19 years.…”

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 14: Sickle Cell Trait

“…That SCT can be responsible for lethal sudden collapse, 7 including on the athletic field, is based on evidence from the forensic-based US National Sudden Death in Athletes Registry 4,8,9 and other databases, 10 as well as numerous case reports and considerable expert experience acquired in athletic venues. 5 The epidemiology and characterization of SCTrelated events in athletes are evolving.…”