Stroke Risk Rises in People with Sickle Cell Disease Despite Treatment Guidelines
A new study reveals that stroke rates are continuing to rise among both adults and children living with sickle cell disease (SCD), despite established standards of care aimed at reducing their risk.
Individuals with SCD are particularly susceptible to strokes caused by either a burst or a blockage in a blood vessel leading to the brain, according to researchers.
Following a landmark clinical trial in 1998, doctors began regularly administering red blood cell transfusions to high-risk children with SCD to lower their odds of having a stroke. However, recent research indicates that the risk of stroke doubles with every 20 years of age, continuing to increase as patients grow older.
The study, published in September 2024 in the journal Blood, found that the risk of a hemorrhagic stroke increases 13-fold between ages 20 and 60 for individuals with SCD. Researchers analyzed data from California emergency rooms and hospitals, identifying more than 7,600 patients with sickle cell disease. Nearly 10% of these patients experienced a stroke in subsequent years.
“Even in children, who probably get the best care for patients with SCD in this country, these trends are opposite what we would hope,” said senior researcher Dr. Ted Wun, Associate Dean for Clinical and Translational Research at the University of California, Davis School of Medicine.
The study suggests that the rising stroke rates may be due to insufficient regular brain ultrasounds to assess stroke risk in SCD patients. Additionally, doctors may not be administering enough blood transfusions or regularly prescribing hydroxyurea, a drug that reduces the likelihood of blood cells forming a sickle shape. Other factors contributing to the increased stroke risk in SCD patients include high blood pressure, high cholesterol, and transient blood clots that temporarily block blood vessels leading to the brain.
The rising stroke rates “emphasize the need to pay attention to screenings for high cholesterol, high blood pressure and other risk factors in adults,” said lead researcher Dr. Olubusola Oluwole, Assistant Professor at the University of Pittsburgh.
“As haematologists, our training emphasizes that the risk of stroke is highest in young children, but I think that has resulted in far less attention being paid to adult patients,” Dr. Wun said in a journal news release. “The preventive steps that we know help prevent stroke in the general population are just as important for people living with SCD.”
The researchers hope that this study will stimulate further research on stroke and SCD in adults.
Source: ASH Press Release
