ACC: Sickle cell trait in black athletes tied to sudden cardiac death

Sickle cell trait is a condition most commonly found in African-Americans, and being diagnosed with the condition doesn’t usually cause room for concern. However, evidence presented during a poster session at the American College of Cardiology (ACC) scientific sessions in New Orleans suggests that the condition may have some association with sudden cardiac death, specifically in young athletes.

In 2006, a freshman cornerback at Rice University died during an extensive period of 100 yard sprints during practice. The family sued the National Collegiate Athletic Association (NCAA) urging that the association should mandate testing for the genetic trait to all student athletes prior to participation. Because of this suit, and a number of other student deaths that were linked to sickle cell trait, in August 2010 the NCAA integrated mandated sickle cell trait screening for all Division I athletes, no matter their race.

Due to this mandate, Kevin M. Harris, MD, a cardiologist at the Minneapolis Heart Institute and colleagues evaluated 30 years worth of data from the U.S. National Registry of Sudden Death in Athletes database to better understand the frequency and profile of sickle cell trait deaths.

Of the 2,387 deaths within the registry, 22 athletes who died had sickle cell trait. Of those 22, sickle cell trait was reported to be the primary cause of death in 15 cases, or 1 percent. The average age of these patients was 18.5, all were African-American and 20 were male.

Twenty-one of these student deaths occurred during the training process, and the majority, were football players. Eighteen were football players, three played basketball and one was a track runner. "If you look at this overall series of athletes, football was one-third of the deaths in the database and was 82 percent of those dying with sickle cell trait. This is an interesting finding,” Harris said in an interview.

Additionally, Harris said that 11 of those who died had rhabdomyolysis, a complication that is often associated with sickle cell trait. The researchers also concluded that environmental conditions could not be excluded as contributing factors to death and said that 16 of the deaths occurred in weather that was above 80 degrees.

While both Harris and the NCAA agree that athletes screened for sickle cell trait should not be excluded from athletics, proper and appropriate training precautions must be taken to ensure thier proper care and help prevent death. This management includes a slower build up to maximum activity and good hydration, among other things.

“These data arereally the first step to understanding sickle cell trait,” Harris offered. Others have also argued that pre-participation screening should include other tests like the electrocardiogram which would help depict other cardiac conditions beyond sickle cell trait; however, Harris said the future of atheletic screening is still unknown.

“It’s always hard to know when you are screening someone what you should be doing and the big discussion will be where we go from here. Do we screen more, and does screening make a difference or will it save lives?

“Coaching and training staff should be able to modify activity by appropriate recognition and appropriate modification of sickle cell trait,” concluded Harris. “And if this occurs with screening there is a great potential to prevent these deaths.”