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scientific articles

Sickle cell trait and incident ischemic stroke in the Atherosclerosis Risk in Communities study

key information

source: Stroke

year: 2014

authors: Caughey MC, Loehr LR, Key NS, Derebail VK, Gottesman RF, Kshirsagar AV, Grove ML, Heiss G

summary/abstract:

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 blacks (n=3497; mean age=54 years; female=62%) was followed from 1987 to 2011 in the Atherosclerosis Risk in Communities (ARIC) study, 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. Models were adjusted for age, sex, smoking, diabetes mellitus, hypertension, total cholesterol, atrial fibrillation, and coronary heart disease.

RESULTS:
SCT was identified in 223 (6.4%) participants. During 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 those with homozygous hemoglobin A (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.

CONCLUSIONS:
We observed an increased risk of ischemic stroke in blacks with SCT. Further investigation of the incidence and pathophysiology of stroke in patients with SCT is warranted.

organization: University of North Carolina at Chapel Hill; Johns Hopkins University School of Medicine,Baltimore; The University of Texas Health Science Center

DOI: 10.1161/STROKEAHA.114.006110

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