Sickle Cell Trait Is a Risk Factor for Early Stroke

Golomb, Meredith R.

doi:10.1001/archneur.62.11.1778

Cited by 20 publications

(12 citation statements)

References 42 publications

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“…Interestingly, a 10-fold higher risk for hemorrhagic stroke and a 15-fold lower risk for ischemic stroke were observed in patients with SCT, compared to Guadeloupians with normal hemoglobin 22 . This study has been criticized for diagnosing stroke type by computed tomography, which may not distinguish between primary hemorrhages and hemorrhagic bleeding secondary to infarctions, causing possible under-diagnosis of ischemic stroke 3 . It is also uncertain whether the Guadeloupe population, an admixture of European, African, Indian, and Amerindian ancestries, can be generalized to African Americans.…”

Section: Discussionmentioning

confidence: 99%

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Sickle Cell Trait and Incident Ischemic Stroke in the Atherosclerosis Risk in Communities Study

Caughey

Loehr

Key

et al. 2014

Stroke

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Background and Purpose Numerous case reports describe stroke in individuals with sickle cell trait (SCT) in the absence of traditional risk factors for cerebrovascular disease. To date, no prospective epidemiological studies have investigated this association. Methods A population-based sample of African Americans (N=3,497, mean age=54, female=62%) was followed from 1987–2011 in the Atherosclerosis Risk in Communities Study (ARIC), contributing a total of 65,371 person-years. Hazard ratios and incidence rate differences for ischemic stroke were estimated, contrasting SCT to homozygous hemoglobin A (HbAA). Models were adjusted for age, sex, smoking, diabetes, hypertension, total cholesterol, atrial fibrillation, and coronary heart disease. Results SCT was identified in 223 (6.4%) participants. Over a median follow up of 22 years, 401 subjects experienced incident stroke (89% ischemic). Incident ischemic stroke was more frequent among those with SCT (13%) than HbAA (10%). SCT was associated with an ischemic stroke hazard ratio of 1.4 (1.0 – 2.0), and an incidence rate difference amounting to 1.9 (0.4 – 3.8) extra strokes per 1000 person-years. Conclusion We observed an increased risk of ischemic stroke in African Americans with SCT. Further investigation of the incidence and pathophysiology of stroke in SCT patients is warranted.

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Section: Discussionmentioning

confidence: 99%

“…Sickle cell trait (SCT), the heterozygous carrier state of sickle cell anemia, is a debated risk factor for stroke 3,4 . With a heterozygous allelic frequency of 7 – 9% in African Americans, and 0.2% in non-Hispanic whites 5 , SCT is estimated to affect over 3 million Americans.…”

Section: Introductionmentioning

confidence: 99%

Sickle Cell Trait and Incident Ischemic Stroke in the Atherosclerosis Risk in Communities Study

Caughey

Loehr

Key

et al. 2014

Stroke

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“…Sickle cell trait (SCT) carriers are characterized by the presence of both HbA and HbS (AS genotype) in their RBCs. Individuals with SCT are usually asymptomatic, although it has recently been demonstrated that cardiovascular risk might be increased in SCT carriers (1,8,17). In addition, SCT has been associated with diminished exercise tolerance (9), increased risk of sudden death, and diminished physical performance under stressful physiological conditions (22,39).…”

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confidence: 99%

Effects of progressive and maximal exercise on plasma levels of adhesion molecules in athletes with sickle cell trait with or without α-thalassemia

Monchanin¹,

Serpero²,

Connes³

et al. 2007

Journal of Applied Physiology

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The aim of the study was to examine the effects of exercise on soluble vascular cell adhesion molecule-1 (sVCAM-1) and intercellular adhesion molecule-1 (sICAM-1) in sickle cell trait (SCT) athletes with or without α-thalassemia. Six athletes with SCT, seven athletes with both SCT and α-thalassemia (SCTAT), and seven control athletes (Cont) performed an incremental and maximal test on cycloergometer. Levels of sICAM-1 and sVCAM-1 were assessed at rest, immediately after the end of exercise, and 1, 2, and 24 h after exercise. Although Cont and SCTAT groups exhibited similar basal plasma levels of inflammatory and adhesion molecules, the SCT group had higher sVCAM-1 basal concentrations. Incremental exercise resulted in a significant increase of sVCAM-1 in all subjects, which remained elevated only in the SCT group during the recovery period. In conclusion, as sVCAM-1 increased with exercise and during the recovery period, our findings support the concept that SCT athletes might be at risk for microcirculatory disturbances and adhesive phenomena developing at rest and several hours after exercise. α-Thalassemia might be considered protective among exercising SCT subjects.

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“…Golomb cites 17 reports of stroke in children and adults with SCT. As no risk factors for stroke were identified, Golumb concluded that SCT had an etiological role in the development of the stroke [58]. To support his argument, Golumb focused on the observation that at autopsy, thrombi of sickled cells were identified in multiple vessels [58].…”

Section: Vascular Healthmentioning

confidence: 99%

Sickle Cell Trait from a Metabolic, Renal, and Vascular Perspective: Linking History, Knowledge, and Health

Thoreson

O’Connor

Ricks

et al. 2014

J. Racial and Ethnic Health Disparities

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Sickle cell trait (SCT) is at the intersection of genetics, social policy, and medicine. SCT occurs in three-hundred million people worldwide and in approximately 8 % of African-Americans. There has been great debate about the influence of SCT on health. Yet data exist, albeit controversial, which suggest that SCT is associated with metabolic derangements that can lead to sudden death after vigorous physical activity, renal dysfunction, thromboembolic events, and stroke. In addition, it has even been postulated that SCT might enhance the vascular complications of diabetes. This review focuses on (a) the scientific breakthroughs that led to the discovery of hemoglobin S, sickle cell disease, and SCT, (b) the history of screening programs in the United States, (c) the incidence and etiology of exercise-related sudden death in military personnel and athletes with SCT, and (d) the data examining the potential chronic disease consequences of SCT from a metabolic, renal, and vascular perspective.

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Sickle Cell Trait Is a Risk Factor for Early Stroke

Cited by 20 publications

References 42 publications

Sickle Cell Trait and Incident Ischemic Stroke in the Atherosclerosis Risk in Communities Study

Sickle Cell Trait and Incident Ischemic Stroke in the Atherosclerosis Risk in Communities Study

Effects of progressive and maximal exercise on plasma levels of adhesion molecules in athletes with sickle cell trait with or without α-thalassemia

Sickle Cell Trait from a Metabolic, Renal, and Vascular Perspective: Linking History, Knowledge, and Health

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