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SICKLE-CELL TRAIT INCREASES RISK OF SUDDEN DEATH WITH EXERTION.

Over the years, there have been case reports of sudden death during physical exertion in people with sickle-cell trait. A report from Kark and colleagues provides conclusive evidence that the risk of exercise-related death in these persons is real.

The authors examined all deaths among 2 million enlisted Army recruits over a four-year period. The authors divided deaths into several categories: sudden, unexplained death; sudden, explained death; and non-sudden death.

The risk of sudden, unexplained death was 27 times higher in black recruits with sickle-cell trait than black recruits without hemoglobin S. The risk increased with age. All 12 cases of sudden, unexplained death in subjects with sickle- cell trait occurred during physical exertion. Although it remains possible that subjects with sickle-cell trait had unique risk factors that those without the trait did not (such as the use of cocaine), it seems unlikely.

This outstanding study raises an obvious and important question: Would a similar increased risk of sudden death be found among persons with sickle-cell trait during times of exertion other than the exceptional rigor of basic training? It seems prudent to advise otherwise healthy patients with sickle-cell trait not to overexert themselves, especially at high altitudes or in extreme heat.

— ALK

Published in Journal Watch General Medicine September 29, 1987

Citation(s):

Kark J A; Posey D M; Schumacher H R; Ruehle C J. Sickle-cell trait as a risk factor for sudden death in physical training. N Engl J Med 1987 Sep 317 781-787.

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