Abstract P023: Association of Sickle Cell Trait with Common Electrocardiographic Abnormalities in The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Introduction: Sickle cell disease (SCD) arises from an autosomal recessive mutation that leads to progressive vascular obstruction and early death. Sickle cell trait (SCT), the carrier status, is present in ~8% of African-Americans (AA) and is thought to be a benign condition, although evidence now suggests an association with worse cardiovascular and renal outcomes. Electrocardiogram (ECG) changes have been documented in SCD patients; however, similar studies in SCT individuals are lacking. We hypothesized that left ventricular hypertrophy (LVH), atrial fibrillation (AF) and QTc prolongation would be more common in SCT carriers than non-carriers.
Methods: SCT was genotyped in 10,731 AA participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Baseline risk factors were recorded from 2003-7. LVH was determined using Sokolow-Lyon criteria for all participants, and Cornell criteria in those with 12 lead ECGs (n = 8,690). AF was based on both self-report and ECG criteria. We assessed the association of SCT with LVH, AF, and QTc using multivariable logistic regression adjusting for age, sex, income, education, self-reported history of stroke, myocardial Infarction, diabetes, hypertension, and chronic kidney disease.
Results: Among AA participants with ECG data and genotyping, 787 of 10,553 were SCT carriers (7.5%). AF was present in 814 (7.8%), LVH in 1,556 (14.7%) and QTc prolongation in 357 (3.4%). SCT status was associated with AF with an adjusted OR of 1.36 (95% CI 1.05, 1.76). SCT was not associated with LVH by Cornell criteria or Sokolow-Lyon (OR 1.16; 95% CI 0.94, 1.42). There was a significant age (continuous) by SCT interaction (p=0.02) with SCT associated with increased risk of LVH in younger but not older individuals. When stratified by the mean age of the cohort (65 years), younger individuals with SCT had an OR of 1.50 (95% CI 1.14, 1.97) for LVH, an association not seen in older individuals (OR 0.86; 95% CI 0.63-1.18). QTc prolongation was not associated with SCT (OR 0.97, 95% CI 0.64-1.47).
Conclusions: SCT was associated with increased prevalence of AF in all individuals and with LVH in younger but not older individuals and was not associated with QTc prolongation. These data suggest SCT is not benign, and for the first time report the association of SCT with common ECG abnormalities. The association with AF and LVH is concerning with respect to increased stroke risk, especially the increased prevalence of LVH seen at younger ages in SCT. These data raise the question of whether individuals with SCT need more intensive monitoring and/or hypertension control than the general population.
Author Disclosures: D. Douce: None. E.Z. Soliman: None. R.P. Naik: None. H.I. Hyacinth: None. M. Cushman: None. C.A. Winkler: None. G. Howard: None. N.A. Zakai: None.
- © 2017 by American Heart Association, Inc.