title: Sickle cell trait and incident ischemic stroke in the Atherosclerosis Risk in Communities study.
abstract: OBJECTIVE
  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.
authors.affiliation: From the Departments of Medicine (M.C.C., N.S.K., V.K.D., A.V.K.) and Epidemiology (M.C.C., L.R.L., G.H.), University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD (R.F.G.); and School of Public Health, Human Genetics Center, The University of Texas Health Science Center, Houston (M.L.G.).
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Caughey
authors.affiliation: From the Departments of Medicine (M.C.C., N.S.K., V.K.D., A.V.K.) and Epidemiology (M.C.C., L.R.L., G.H.), University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD (R.F.G.); and School of Public Health, Human Genetics Center, The University of Texas Health Science Center, Houston (M.L.G.).
authors.forename: Laura R
authors.initials: LR
authors.lastname: Loehr
authors.affiliation: From the Departments of Medicine (M.C.C., N.S.K., V.K.D., A.V.K.) and Epidemiology (M.C.C., L.R.L., G.H.), University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD (R.F.G.); and School of Public Health, Human Genetics Center, The University of Texas Health Science Center, Houston (M.L.G.).
authors.forename: Nigel S
authors.initials: NS
authors.lastname: Key
authors.affiliation: From the Departments of Medicine (M.C.C., N.S.K., V.K.D., A.V.K.) and Epidemiology (M.C.C., L.R.L., G.H.), University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD (R.F.G.); and School of Public Health, Human Genetics Center, The University of Texas Health Science Center, Houston (M.L.G.).
authors.forename: Vimal K
authors.initials: VK
authors.lastname: Derebail
authors.affiliation: From the Departments of Medicine (M.C.C., N.S.K., V.K.D., A.V.K.) and Epidemiology (M.C.C., L.R.L., G.H.), University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD (R.F.G.); and School of Public Health, Human Genetics Center, The University of Texas Health Science Center, Houston (M.L.G.).
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.affiliation: From the Departments of Medicine (M.C.C., N.S.K., V.K.D., A.V.K.) and Epidemiology (M.C.C., L.R.L., G.H.), University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD (R.F.G.); and School of Public Health, Human Genetics Center, The University of Texas Health Science Center, Houston (M.L.G.).
authors.forename: Abhijit V
authors.initials: AV
authors.lastname: Kshirsagar
authors.affiliation: From the Departments of Medicine (M.C.C., N.S.K., V.K.D., A.V.K.) and Epidemiology (M.C.C., L.R.L., G.H.), University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD (R.F.G.); and School of Public Health, Human Genetics Center, The University of Texas Health Science Center, Houston (M.L.G.).
authors.forename: Megan L
authors.initials: ML
authors.lastname: Grove
authors.affiliation: From the Departments of Medicine (M.C.C., N.S.K., V.K.D., A.V.K.) and Epidemiology (M.C.C., L.R.L., G.H.), University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD (R.F.G.); and School of Public Health, Human Genetics Center, The University of Texas Health Science Center, Houston (M.L.G.).
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
mesh_terms: D001741:Black or African American / Q000235:genetics; D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000235:genetics; D015331:Cohort Studies; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D012805:Sickle Cell Trait / Q000150:complications*; D020521:Stroke / Q000453:epidemiology* / Q000235:genetics*
keywords: epidemiology; sickle cell trait; stroke