NEW research examining nearly three decades of data from the California Department of Health Care Access and Innovation reveals a concerning rise in stroke rates among both children and adults with sickle cell disease (SCD). The findings emphasise the importance of ongoing prevention efforts, particularly in adults, and highlight the need for better management of cerebrovascular risk factors such as hypertension and hyperlipidaemia.
The study analysed emergency department and hospitalisation data from 7,636 individuals with SCD between 1991 and 2019. A key focus was comparing the incidence of strokes and transient ischemic attacks (TIAs) before and after the introduction of chronic blood transfusions as a standard of care for children at high risk of stroke, following the landmark STOP trial in 1998.
The results showed a cumulative incidence of ischemic strokes in people with SCD of 2.1% (95% CI, 1.8%-2.4%) by age 20 and 13.5% (95% CI, 12.3%-14.7%) by age 60. The cumulative incidence of intracranial haemorrhage (ICH) was lower, with rates of 0.5% (95% CI, 0.4%-0.7%) by age 20 and 6.8% (95% CI, 5.9%-7.7%) by age 60.
Despite the transient decrease in stroke rates following the STOP trial, the data indicate that ischemic stroke rates in children have risen in recent years. Between 2010 and 2019, the ischemic stroke rate in children under 18 was 234.9 per 100,000 person-years, compared to 165.1 per 100,000 person-years in the previous decade (P=0.012). In adults aged 31-50, the ischemic stroke rate increased to 431.1 per 100,000 person-years from 303.2 per 100,000 person-years in the prior decade (P=0.031).
Additionally, the study revealed an increase in ICH rates in individuals aged 18-30, as well as a rise in TIA rates in children under 18 during the 2010-2019 period compared to the preceding decade. Risk factors such as increasing age, hypertension, and hyperlipidaemia were associated with a higher likelihood of stroke and TIA, underscoring the need to address these modifiable factors.
The findings suggest that while early interventions like chronic transfusions have had a positive impact on preventing strokes in children, additional efforts are needed to manage cerebrovascular risk factors, particularly in adults with SCD. These modifiable risk factors, which have proven effective in the general population, could be key to preventing the rise in stroke rates among SCD patients.
Abigail Craig, EMJ
Reference
Oluwole OB et al. Rates of Strokes in Californians with Sickle Cell Disease in the Post-STOP Era. Blood. 2024;DOI: 10.1182/blood.2023023031.
