Thirty‐year risk of ischemic stroke in individuals with sickle cell trait and modification by chronic kidney disease: The atherosclerosis risk in communities (ARIC) study. Issue 12 (10th September 2019)

• Record Type: Journal Article
• Authors: Caughey, Melissa C.; Derebail, Vimal K.; Key, Nigel S.; Reiner, Alexander P.; Gottesman, Rebecca F.; Kshirsagar, Abhijit V.; Heiss, Gerardo
• Is Part Of: American journal of hematology. Volume 94:Issue 12(2019:Dec.)
• Page Start: 1306
• Page End: 1313
• Publication Date: 2019-09-10
• Subjects: Hematology -- Periodicals; 616.15
• DOI: 10.1002/ajh.25615
• Languages: English
• ISSNs: 0361-8609

Abstract

Abstract: Sickle cell trait (SCT) has been associated with hypercoagulability, chronic kidney disease (CKD), and ischemic stroke. Whether concomitant CKD modifies long‐term ischemic stroke risk in individuals with SCT is uncertain. We analyzed data from 3602 genotyped black adults (female = 62%, mean baseline age = 54 years) who were followed for a median 26 years by the Atherosclerosis Risk in Communities Study. Ischemic stroke was verified by physician review. Associations between SCT and ischemic stroke were analyzed using repeat‐events Cox regression, adjusted for potential confounders. SCT was identified in 236 (7%) participants, who more often had CKD at baseline than noncarriers (18% vs 13%, P = .02). Among those with CKD, elevated factor VII activity was more prevalent with SCT genotype (36% vs 22%; P = .05). From 1987‐2017, 555 ischemic strokes occurred in 436 individuals. The overall hazard ratio of ischemic stroke associated with SCT was 1.31 (95% CI: 0.95‐1.80) and was stronger in participants with concomitant CKD (HR = 2.18; 95% CI: 1.16‐4.12) than those without CKD (HR = 1.09; 95% CI: 0.74‐1.61); P for interaction = .04. The hazard ratio of composite ischemic stroke and/or death associated with SCT was 1.20 (95% CI: 1.01‐1.42) overall, 1.44 (95% CI: 1.002‐2.07) among those with CKD, and 1.15 (95% CI: 0.94‐1.39) among those without CKD; P for interaction = .18. The long‐term risk of ischemic stroke associated with SCT relative to noncarrier genotype appears to be modified by concomitant CKD.