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Ismail AM, Nour BM, Abakar AD, Almugadam BS, Altayb HN, Ahmed RT, Elkarsany MEM. Association of Normal and Mutated APOL1 G2 Rs60910145 alleles with SCD, Body Mass Index, and Renal Function Biomarkers and Indices. Curr Res Transl Med 2024; 72:103414. [PMID: 38246019 DOI: 10.1016/j.retram.2023.103414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/30/2023] [Accepted: 09/28/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE OF THE STUDY The current study aimed to detect the frequency of normal and mutated APOL1 alleles in sickle cell disease (SCD) patients and test their relation with Microalbuminuria, Creatinine, Urea, Glomerular Filtration Rate (GFR), and Body Mass Index (BMI). PATIENTS AND METHODS The study included 156 SCD subjects. Serum Creatinine (mg/dl) and Urea (mg/dl) as well as Microalbuminuria (mg/l) level were measured by using Biosystems kit (Biosystems, Barcelona, Spain) and Mindary BA88A semi-automated biochemistry analyzer. Glomerular filtration rate and body mass index were calculated by equations. Blood DNA extraction was achieved by using the modified G-DEX™IIb Genomic DNA Extraction Kit protocol. The PCR was done for the detection of the APOL1 G2 rs60910145 alleles by using allele-specific PCR and primers. RESULTS The CC allele was more frequent in study cases (66.7%) than TT allele. The frequency of a mutated allele (CC) was insignificantly higher in males (67.8%) than in females (65.2%) and in rural (70.9%) than urban areas. It is also higher in Shankhab compared to other tribes and subjects 26-37 years compared to other, P˃0.05. Interstingly, the subjects who carry the CC allele showed a significantly higher level of Microalbuminuria, Creatinine, BMI, and Urea compared to those carry TT allele. Moreover, GFR is also higher in subjects who carry CC than TT allele but it is not significant. CONCULSION Altogether, the study findings highlighted the link of normal and mutated APOL1 G2 rs60910145 alleles with SCD and displayed the significant value of mutated APOL1 allele in the prediction of early nephropathy in SCD patients.
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Affiliation(s)
- Abazar Mahmoud Ismail
- Department of clinical chemistry, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan; Department of clinical chemistry, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Bakri Mohammed Nour
- Department of Medical Parasitology, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan
| | - Adam Dawoud Abakar
- Department of Medical Parasitology, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan
| | - Babiker Saad Almugadam
- Department of Microbiology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Hisham N Altayb
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; Center of Artificial Intelligence in Precision Medicines, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Rania TagEsir Ahmed
- Department of Epidemiology, Tropical Medicine Research Institute, National Center of Reserch, Sudan
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Evangelidis P, Venou TM, Fani B, Vlachaki E, Gavriilaki E. Endocrinopathies in Hemoglobinopathies: What Is the Role of Iron? Int J Mol Sci 2023; 24:16263. [PMID: 38003451 PMCID: PMC10671246 DOI: 10.3390/ijms242216263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Hemoglobinopathies, including β-thalassemia and sickle cell disease (SCD), are common genetic blood disorders. Endocrine disorders are frequent manifestations of organ damage observed mainly in patients with β-thalassemia and rarely in SCD. Iron overload, oxidative stress-induced cellular damage, chronic anemia, and HCV infection contribute to the development of endocrinopathies in β-thalassemia. The above factors, combined with vaso-occlusive events and microcirculation defects, are crucial for endocrine dysfunction in SCD patients. These endocrinopathies include diabetes mellitus, hypothyroidism, parathyroid dysfunction, gonadal and growth failure, osteoporosis, and adrenal insufficiency, affecting the quality of life of these patients. Thus, we aim to provide current knowledge and data about the epidemiology, pathogenesis, diagnosis, and management of endocrine disorders in β-thalassemia and SCD. We conducted a comprehensive review of the literature and examined the available data, mostly using the PubMed and Medline search engines for original articles. In the era of precision medicine, more studies investigating the potential role of genetic modifiers in the development of endocrinopathies in hemoglobinopathies are essential.
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Affiliation(s)
- Paschalis Evangelidis
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Theodora-Maria Venou
- Adult Thalassemia Unit, 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Hippocration General Hospital, 54642 Thessaloniki, Greece; (T.-M.V.); (E.V.)
| | | | - Efthymia Vlachaki
- Adult Thalassemia Unit, 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Hippocration General Hospital, 54642 Thessaloniki, Greece; (T.-M.V.); (E.V.)
| | - Eleni Gavriilaki
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
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Hulsizer J, Resurreccion WK, Shi Z, Wei J, Ladson-Gary S, Zheng SL, Helfand BT, Billings L, Caplan MS, Xu J. Sickle Cell Trait and Risk for Common Diseases: Evidence from the UK Biobank. Am J Med 2022; 135:e279-e287. [PMID: 35461807 DOI: 10.1016/j.amjmed.2022.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sickle cell trait is typically considered benign. Although evidence remains inconsistent, recent studies suggest that it is associated with several common diseases. We systematically assessed associations of sickle cell trait with reported diseases in a large population-based cohort. METHODS Study subjects were self-reported Blacks from the UK Biobank (UKB), a United Kingdom population-based cohort of subjects aged 40-69 years at recruitment in the United Kingdom. Sickle cell status was based on the International Classification of Diseases, Tenth Revision (ICD-10) or mutations in the HBB gene. Diagnoses of diseases were obtained from ICD-10 and self-reports. Associations of sickle cell trait and diseases were tested using logistic regression, adjusting for age at recruitment, sex, and genetic background (top 10 principal components). RESULTS Among the 8019 Blacks in the UKB, 699 (8.72%) were sickle cell trait carriers; the rate was significantly higher in females (9.74%) than males (7.48%), P = .0005. Sickle cell trait was under-diagnosed; most heterozygous hemoglobin subunit beta (HBB) gene Glu6Val carriers did not have a sickle cell trait ICD-10 record. Compared with non-sickle cell trait, sickle cell trait carriers had significantly increased risk for type 2 diabetes; odds ratio 1.38; 95% confidence interval, 1.12-1.68; P = .002. Sickle cell trait was also significantly associated with increased risk for renal diseases (rhabdomyolysis, end-stage renal disease, chronic kidney disease, renal papillary necrosis) and vascular diseases (hypertension, retinopathy, non-ischemic stroke), P < .05. While most of these diseases are complications/comorbidities of diabetes, their associations with sickle cell trait remained significant after adjusting for diabetes. Association with end-stage renal disease was stronger in subjects without diabetes, odds ratio 6.45; 95% confidence interval, 1.93-19.61; P = .001. CONCLUSIONS Sickle cell trait is significantly associated with increased risk for diabetes and diabetes-related complications/comorbidities.
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Affiliation(s)
| | | | - Zhuqing Shi
- Program for Personalized Cancer Care, Evanston, Ill
| | - Jun Wei
- Program for Personalized Cancer Care, Evanston, Ill
| | | | | | - Brian T Helfand
- Program for Personalized Cancer Care, Evanston, Ill; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill; Department of Surgery, University of Chicago Pritzker School of Medicine, Ill
| | - Liana Billings
- Department of Medicine, NorthShore University HealthSystem, Evanston, Ill; Department of Medicine, University of Chicago Pritzker School of Medicine, Ill
| | - Michael S Caplan
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, Ill; Department of Pediatrics, University of Chicago Pritzker School of Medicine, Ill
| | - Jianfeng Xu
- Program for Personalized Cancer Care, Evanston, Ill; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill; Department of Surgery, University of Chicago Pritzker School of Medicine, Ill.
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Kweka BV, Fredrick C, Kitilya B, Jeremiah K, Lyimo E, Filteau S, Rehman AM, Friis H, Olsen MF, Faurholt-Jepsen D, Krogh-Madsen R, PrayGod G. Association of sickle cell trait with β-cell dysfunction and physical activity in adults living with and without HIV in Tanzania. APMIS 2022; 130:230-239. [PMID: 35167170 PMCID: PMC9314065 DOI: 10.1111/apm.13214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/11/2022] [Indexed: 12/15/2022]
Abstract
This study aimed to investigate sickle cell trait (SCT) associations with physical activity, markers of insulin secretion and resistance, and glucose among people living with HIV infection (PLWH), both antiretroviral therapy (ART) naive and experienced, and HIV-uninfected adults. This was a cross-sectional study conducted in Mwanza, Northwestern Tanzania. We used data of 668 participants attained from two sub-studies of CICADA study. Mean age was 40 (SD 11.5) years, 402 (61.7%) were females and 157 (24.1%) had SCT. PLWH were 422 (64.7%), of these, 80 (18.9%) were on ART. People with SCT had higher risk of having an isolated β-cell dysfunction compared to those without SCT (RRR = 1.82, CI: 1.10, 3.01, p = 0.02). People with SCT but without HIV infection had lower average acceleration on the trunk longitudinal axis (ACCx) and higher level of self-reported physical activity. 30 min oral glucose tolerance test among PLWH on ART was higher in those with SCT compared to those without SCT. People with SCT are at higher risk of having β-cell dysfunction and those with SCT on ART are at more risk of developing diabetes. Future studies to investigate the interaction between SCT and HIV/ART on risk of diabetes should be considered.
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Affiliation(s)
- Belinda V Kweka
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Cyprian Fredrick
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Brenda Kitilya
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Kidola Jeremiah
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Eric Lyimo
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrea M Rehman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mette F Olsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Rikke Krogh-Madsen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
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Masimango MI, Jadoul M, Binns-Roemer EA, David VA, Sumaili EK, Winkler CA, Limou S. APOL1 Renal Risk Variants and Sickle Cell Trait Associations With Reduced Kidney Function in a Large Congolese Population-Based Study. Kidney Int Rep 2021; 7:474-482. [PMID: 35257060 PMCID: PMC8897685 DOI: 10.1016/j.ekir.2021.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Mannix Imani Masimango
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Michel Jadoul
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Elizabeth A. Binns-Roemer
- Basic Science Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, Maryland, USA
| | - Victor A. David
- Basic Science Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, Maryland, USA
| | - Ernest Kiswaya Sumaili
- Department of Nephrology, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Cheryl A. Winkler
- Basic Science Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, Maryland, USA
| | - Sophie Limou
- Basic Science Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, Maryland, USA
- Institute for Transplantation in Urology-Nephrology, Centre de Recherche en Transplantation et Immunologie, UMR1064, Institut National de la Santé et de la Recherche Médicale, Université de Nantes, Nantes, France
- Ecole Centrale de Nantes, Computer sciences and Mathematics in Biology Department, Nantes, France
- Correspondence: Sophie Limou, Centre de Recherche en Transplantation et Immunologie, Institut National de la Santé et de la Recherche Médicale, UMR1064 - Team 5, 30 bd Jean Monnet, 44093 Nantes Cedex 1, France.
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Akinbodewa AA, Ogunleye A, Adejumo OA. Prevalence of sickle cell trait and its association to renal dysfunction among blood donors at University of Medical Sciences Teaching Hospital, Ondo, Nigeria. Afr Health Sci 2021; 21:1237-1242. [PMID: 35222587 PMCID: PMC8843258 DOI: 10.4314/ahs.v21i3.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Prospective blood donors are routinely screened for blood borne infections but medical illnesses and haemoglobin genotype are overlooked despite a high prevalence of haemoglobin AS among Nigerian donors. Objective To determine the prevalence of haemoglobin AS and its association to renal function, if any. Method Apparently healthy donors were studied between February and December 2018. Their haemoglobin genotype and, estimated glomerular filtration rates were determined. Results There were 96 males (94.1%) and 6 (5.9%) females with mean age of 26.7±4.5 years (range 19–44 years) and mean eGFR of 103.97±19.00ml/min/1.73m2. Eighty one (79.4%) and 21 (20.6%) subjects had haemoglobin AA and AS genotypes respectively. The mean eGFR for subjects with haemoglobin AA and AS were 105.2±18.6ml/min/1.73m2 and 99.9 ± 21.2ml/min/1.73m2 respectively (p value = 0.270). Eighty one (79.4%), 20 (19.6%) and 1 (1.0%) subjects had renal function at >90ml/min/1.73m2, 60–89ml/min/1.73m2 and 30–59ml/min/m2 respectively. There was no significant difference in the mean eGFR between subjects with haemoglobin AA and AS (mean difference 5.3, p = 0.265, 95%CI = -4.07 to 14.60). Conclusion The prevalence of sickle cell trait among Nigerian blood donors is high. There is no significant difference in the renal function status of blood donors with SCT and normal haemoglobin genotype.
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Affiliation(s)
| | - Adeyemi Ogunleye
- Department of Medical Laboratory Services, University of Medical Sciences Teaching Hospital, Ondo State
| | - Oluseyi Ademola Adejumo
- Kidney Care Centre, department of Medicine, University of Medical Sciences Teaching Hospital, Ondo State
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7
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Hyacinth HI, Franceschini N, Seals SR, Irvin MR, Chaudhary N, Naik RP, Alonso A, Carty CL, Burke GL, Zakai NA, Winkler CA, David VA, Kopp JB, Judd SE, Adams RJ, Gee BE, Longstreth WT, Egede L, Lackland DT, Greenberg CS, Taylor H, Manson JE, Key NS, Derebail VK, Kshirsagar AV, Folsom AR, Konety SH, Howard V, Allison M, Wilson JG, Correa A, Zhi D, Arnett DK, Howard G, Reiner AP, Cushman M, Safford MM. Association of Sickle Cell Trait With Incidence of Coronary Heart Disease Among African American Individuals. JAMA Netw Open 2021; 4:e2030435. [PMID: 33399855 PMCID: PMC7786247 DOI: 10.1001/jamanetworkopen.2020.30435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE The incidence of and mortality from coronary heart disease (CHD) are substantially higher among African American individuals compared with non-Hispanic White individuals, even after adjusting for traditional factors associated with CHD. The unexplained excess risk might be due to genetic factors related to African ancestry that are associated with a higher risk of CHD, such as the heterozygous state for the sickle cell variant or sickle cell trait (SCT). OBJECTIVE To evaluate whether there is an association between SCT and the incidence of myocardial infarction (MI) or composite CHD outcomes in African American individuals. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 5 large, prospective, population-based cohorts of African American individuals in the Women's Health Initiative (WHI) study, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, the Multi-Ethnic Study of Atherosclerosis (MESA), the Jackson Heart Study (JHS), and the Atherosclerosis Risk in Communities (ARIC) study. The follow-up periods included in this study were 1993 and 1998 to 2014 for the WHI study, 2003 to 2014 for the REGARDS study, 2002 to 2016 for the MESA, 2002 to 2015 for the JHS, and 1987 to 2016 for the ARIC study. Data analysis began in October 2013 and was completed in October 2020. EXPOSURES Sickle cell trait status was evaluated by either direct genotyping or high-quality imputation of rs334 (the sickle cell variant). Participants with sickle cell disease and those with a history of CHD were excluded from the analyses. MAIN OUTCOMES AND MEASURES Incident MI, defined as adjudicated nonfatal or fatal MI, and incident CHD, defined as adjudicated nonfatal MI, fatal MI, coronary revascularization procedures, or death due to CHD. Cox proportional hazards regression models were used to estimate the hazard ratio for incident MI or CHD comparing SCT carriers with noncarriers. Models were adjusted for age, sex (except for the WHI study), study site or region of residence, hypertension status or systolic blood pressure, type 1 or 2 diabetes, serum high-density lipoprotein level, total cholesterol level, and global ancestry (estimated from principal components analysis). RESULTS A total of 23 197 African American men (29.8%) and women (70.2%) were included in the combined sample, of whom 1781 had SCT (7.7% prevalence). Mean (SD) ages at baseline were 61.2 (6.9) years in the WHI study (n = 5904), 64.0 (9.3) years in the REGARDS study (n = 10 714), 62.0 (10.0) years in the MESA (n = 1556), 50.3 (12.0) years in the JHS (n = 2175), and 53.2 (5.8) years in the ARIC study (n = 2848). There were no significant differences in the distribution of traditional factors associated with cardiovascular disease by SCT status within cohorts. A combined total of 1034 participants (76 with SCT) had incident MI, and 1714 (137 with SCT) had the composite CHD outcome. The meta-analyzed crude incidence rate of MI did not differ by SCT status and was 3.8 per 1000 person-years (95% CI, 3.3-4.5 per 1000 person-years) among those with SCT and 3.6 per 1000 person-years (95% CI, 2.7-5.1 per 1000 person-years) among those without SCT. For the composite CHD outcome, these rates were 7.3 per 1000 person-years (95% CI, 5.5-9.7 per 1000 person-years) among those with SCT and 6.0 per 1000 person-years (95% CI, 4.9-7.4 per 1000 person-years) among those without SCT. Meta-analysis of the 5 study results showed that SCT status was not significantly associated with MI (hazard ratio, 1.03; 95% CI, 0.81-1.32) or the composite CHD outcome (hazard ratio, 1.16; 95% CI, 0.92-1.47). CONCLUSIONS AND RELEVANCE In this cohort study, there was not an association between SCT and increased risk of MI or CHD in African American individuals. These disorders may not be associated with sickle cell trait-related sudden death in this population.
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Affiliation(s)
- Hyacinth I. Hyacinth
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Samantha R. Seals
- Department of Mathematics and Statistics, University of West Florida, Pensacola
| | | | - Ninad Chaudhary
- School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Rakhi P. Naik
- Division of Hematology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cara L. Carty
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Gregory L. Burke
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Neil A. Zakai
- Department of Medicine and Pathology and Laboratory Medicine, University of Vermont, Burlington
| | - Cheryl A. Winkler
- Basic Science Laboratory, National Cancer Institute and Frederick National Laboratory, Leidos Biomedical Research, Frederick, Maryland
| | - Victor A. David
- Basic Science Laboratory, National Cancer Institute and Frederick National Laboratory, Leidos Biomedical Research, Frederick, Maryland
| | - Jeffrey B. Kopp
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Suzanne E. Judd
- School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Robert J. Adams
- Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston
| | - Beatrice E. Gee
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - W. T. Longstreth
- Department of Neurology, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Leonard Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee
| | - Daniel T. Lackland
- Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston
| | - Charles S. Greenberg
- Division of Hematology-Oncology, Medical University of South Carolina, Charleston
| | - Herman Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nigel S. Key
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Vimal K. Derebail
- University of North Carolina Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill
| | - Abhijit V. Kshirsagar
- University of North Carolina Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Suma H. Konety
- Division of Cardiology, University of Minnesota Medical Center, Minneapolis
| | - Virginia Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California San Diego, San Diego
| | - James G. Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson
| | - Adolfo Correa
- Jackson Heart Study, University of Mississippi Medical Center, Jackson
| | - Degui Zhi
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham
| | | | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham
| | | | - Mary Cushman
- Department of Medicine and Pathology and Laboratory Medicine, University of Vermont, Burlington
| | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
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Mishriky BM, Powell JR, Wittwer JA, Chu JX, Sewell KA, Wu Q, Cummings DM. Do GLP-1RAs and SGLT-2is reduce cardiovascular events in black patients with type 2 diabetes? A systematic review and meta-analysis. Diabetes Obes Metab 2019; 21:2274-2283. [PMID: 31168889 DOI: 10.1111/dom.13805] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/30/2019] [Accepted: 06/02/2019] [Indexed: 12/21/2022]
Abstract
AIMS While recent cardiovascular safety trials (CVST) concerning newer diabetes medications included mostly white participants, results are being generalized to all races in recent guidelines. This raises a controversial question regarding the appropriateness of applying CVST data to black patients with type 2 diabetes. MATERIALS AND METHODS We searched for randomized trials comparing diabetes medications to placebo in type 2 diabetes and investigated three- or four-point major adverse cardiovascular events (MACE). Data concerning black patients were then extracted. As the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) updated their recommendations for patients with established cardiovascular risk based on the CVST showing cardiovascular benefit, we performed a sensitivity analysis by including those trials only. RESULTS A total of 11 trials were included, investigating a glucagon-like peptide-1 receptor agonist (GLP-1RA) in five, a sodium-glucose co-transporter-2 inhibitor (SGLT-2i) in two and dipeptidyl peptidase-4 inhibitors (DPP-4i) in four. Of the 102 416 participants enrolled in the included trials, only 4601 were black (4.5%). Pooled results showed no significant difference in the incidence of MACE among diabetes medications (GLP-1RA, SGLT-2i or DPP-4i) and placebo in black patients with type 2 diabetes (relative risk [RR] [95% CI], 0.94 [0.77,1.16]). Restricting the analysis to different classes of diabetes medication, the results remained non-significant. Restricting the analysis to CVST with significant outcomes, the results remained non-significant (RR [95% CI], 0.97 [0.68,1.39]). CONCLUSIONS Given that black patients with type 2 diabetes were not well represented in CVSTs and such trials were underpowered to evaluate racial differences, it remains unclear whether GLP-1RAs or SGLT-2is would reduce cardiovascular risk in such patients, and additional studies targeting black patients are urgently needed.
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Affiliation(s)
- Basem M Mishriky
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - James R Powell
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Jennifer A Wittwer
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Jennifer X Chu
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Kerry A Sewell
- Laupus Health Sciences Library, East Carolina University, Greenville, North Carolina
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, North Carolina
| | - Doyle M Cummings
- Department of Family Medicine, East Carolina University, Greenville, North Carolina
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Xu JZ, Thein SL. The carrier state for sickle cell disease is not completely harmless. Haematologica 2019; 104:1106-1111. [PMID: 31097635 PMCID: PMC6545856 DOI: 10.3324/haematol.2018.206060] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/29/2019] [Indexed: 01/19/2023] Open
Affiliation(s)
- Julia Zhe Xu
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MA, USA
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MA, USA
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10
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Alladagbin DJ, Fernandes PN, Tavares MB, Brito JT, Oliveira GGS, Silva LK, Khouri NA, Oliveira MB, Amorim T, Matos CM, Ribeiro GS, Lopes AA, Gonçalves MS, dos-Santos WLC. The sickle cell trait and end stage renal disease in Salvador, Brazil. PLoS One 2018; 13:e0209036. [PMID: 30557319 PMCID: PMC6296547 DOI: 10.1371/journal.pone.0209036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022] Open
Abstract
Background Carriers of the sickle cell trait (HbAS) usually remain asymptomatic. However, under conditions of low tissue oxygenation, red blood cell sickling and vascular obstruction may develop. Chronic kidney disease (CKD) can arise from conditions promoting low-oxygen in kidney tissue, which may be aggravated by the presence of the sickle cell trait. In addition, CKD can arise from other genetic traits. Aim To compare the frequency of HbAS among hemodialysis patients and the general newborn population of Salvador (Bahia-Brazil), as well as to investigate the frequencies of apolipoprotein L1 risk variants in patients undergoing hemodialysis. Methods A cross-sectional study included 306 patients with ESRD (End Stage Renal Disease) on hemodialysis for no more than three years. Hemoglobin profiles were characterized by high-performance liquid chromatography. To estimate the sickle cell trait frequency in the general population of Salvador, we analyzed data collected by a local neonatal screening program between 2011 and 2016. To exclude the potential contributing effect of the apolipoprotein L1 (APOL1) gene variants, we performed genotyping by PCR and DNA sequencing of 45 patients. Results The frequency of HbAS was significantly higher in hemodialysis patients (9.8%) than in the general population (4.6%): Odds Ratio = 2.32 (95% CI = 1.59–3.38). No differences in demographic, clinical or laboratory data were found among patients with or without the sickle cell trait. The frequency of patients with none, one or two APOL1 risk haplotypes (G1 and G2) for CKD were 80%, 18% and 2%, respectively. Conclusions The frequency of the sickle cell trait is higher in patients with ESRD on hemodialysis compared to the general population. APOL1 haplotypes do not seem to be the determinant of ESRD in these patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tatiana Amorim
- Serviço de Referência em Triagem Neonatal—SRTN, Salvador, Brazil
| | | | - Guilherme S. Ribeiro
- Instituto Gonçalo Moniz-FIOCRUZ-Bahia, Salvador, Brazil
- Universidade da Bahia, Salvador, Brazil
| | | | - Marilda S. Gonçalves
- Instituto Gonçalo Moniz-FIOCRUZ-Bahia, Salvador, Brazil
- Universidade da Bahia, Salvador, Brazil
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11
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Skinner SC, Diaw M, Pialoux V, Mbaye MN, Mury P, Lopez P, Bousquet D, Gueye F, Diedhiou D, Joly P, Renoux C, Sow D, Diop S, Ranque B, Vinet A, Samb A, Guillot N, Connes P. Increased Prevalence of Type 2 Diabetes-Related Complications in Combined Type 2 Diabetes and Sickle Cell Trait. Diabetes Care 2018; 41:2595-2602. [PMID: 30327363 DOI: 10.2337/dc18-1289] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/24/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The prevalence of type 2 diabetes (T2D) is rapidly increasing in sub-Saharan Africa, where sickle cell trait (SCT) is also frequent. Although SCT is generally considered a benign condition, evidence suggests that SCT could exaggerate vascular dysfunction in T2D. However, it remains unclear whether SCT could increase the risk of the development of T2D complications. Therefore, this study was conducted to determine whether T2D complications were more prevalent among Senegalese individuals with SCT and T2D than among those with T2D only. RESEARCH DESIGN AND METHODS Rates of hypertension, retinopathy, peripheral neuropathy, peripheral artery disease, and impaired renal function as well as arterial stiffness, blood rheology, and concentrations of plasma advanced glycation end products (AGEs) and cytokines were compared between groups of Senegalese individuals with combined SCT and T2D (T2D-SCT) (n = 60), T2D (n = 52), SCT (n = 53), and neither T2D nor SCT (control) (n = 56). Human aortic endothelial cell (HAEC) expression of inflammatory and adhesion factors was measured after treatment with tumor necrosis factor-α and subjects' plasma. Effects of AGE inhibition or tiron on HAEC expression of E-selectin were measured. RESULTS Retinopathy, hypertension, and reduced renal function were more prevalent, and arterial stiffness, blood viscosity at high shear rates, and thixotropic index were higher, in the SCT group compared with the other groups. Multivariable analysis showed that plasma AGE concentration was significantly associated with arterial stiffness. E-selectin expression was elevated in HAECs treated with T2D-SCT plasma compared with the other groups, but AGE inhibition reversed this. CONCLUSIONS SCT could potentially augment the risk of the development of T2D-related complications, including retinopathy, nephropathy, and hypertension.
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Affiliation(s)
- Sarah C Skinner
- Inter-university Laboratory of Biology of Motor Function EA7424, Vascular Biology and the Red Blood Cell Team, Claude Bernard University Lyon 1, University de Lyon 1, Villeurbanne, France.,Laboratory of Excellence GR-EX, Paris, France
| | - Mor Diaw
- Laboratory of Physiology and Functional Exploration, Faculté de Medecine de Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Vincent Pialoux
- Inter-university Laboratory of Biology of Motor Function EA7424, Vascular Biology and the Red Blood Cell Team, Claude Bernard University Lyon 1, University de Lyon 1, Villeurbanne, France.,Laboratory of Excellence GR-EX, Paris, France.,Institute of Universities of France, Paris, France
| | | | - Pauline Mury
- Inter-university Laboratory of Biology of Motor Function EA7424, Vascular Biology and the Red Blood Cell Team, Claude Bernard University Lyon 1, University de Lyon 1, Villeurbanne, France.,Laboratory of Excellence GR-EX, Paris, France
| | - Philomène Lopez
- Laboratory of Pharmaceutical Biochemistry, Faculté de Medecine de Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Delphine Bousquet
- CarMeN Laboratory, INSERM 1060, Institut National des Sciences Appliquées 1397, Université Claude Bernard Lyon 1, Institut National des Sciences Appliquées Lyon, Villeurbanne, France
| | - Fatou Gueye
- Laboratory of Pharmaceutical Biochemistry, Faculté de Medecine de Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Demba Diedhiou
- Medical Clinic II, Abass Ndao Hospital Center, Dakar, Senegal
| | - Philippe Joly
- Inter-university Laboratory of Biology of Motor Function EA7424, Vascular Biology and the Red Blood Cell Team, Claude Bernard University Lyon 1, University de Lyon 1, Villeurbanne, France.,Laboratory of Excellence GR-EX, Paris, France.,Laboratory of Biochemistry of Erythrocyte Pathologies, Biology Center East, Bron, France
| | - Céline Renoux
- Inter-university Laboratory of Biology of Motor Function EA7424, Vascular Biology and the Red Blood Cell Team, Claude Bernard University Lyon 1, University de Lyon 1, Villeurbanne, France.,Laboratory of Excellence GR-EX, Paris, France.,Laboratory of Biochemistry of Erythrocyte Pathologies, Biology Center East, Bron, France
| | - Djiby Sow
- Medical Clinic II, Abass Ndao Hospital Center, Dakar, Senegal
| | - Saliou Diop
- Laboratory of Hemato-Immunology, Faculté de Medecine de Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Brigitte Ranque
- Laboratory of Excellence GR-EX, Paris, France.,INSERM, UMR_S970, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Agnès Vinet
- Laboratoire de Pharm-Ecologie Cardiovasculaire, Université d'Avignon, Avignon, France
| | - Abdoulaye Samb
- Laboratory of Physiology and Functional Exploration, Faculté de Medecine de Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Nicolas Guillot
- CarMeN Laboratory, INSERM 1060, Institut National des Sciences Appliquées 1397, Université Claude Bernard Lyon 1, Institut National des Sciences Appliquées Lyon, Villeurbanne, France
| | - Philippe Connes
- Inter-university Laboratory of Biology of Motor Function EA7424, Vascular Biology and the Red Blood Cell Team, Claude Bernard University Lyon 1, University de Lyon 1, Villeurbanne, France .,Laboratory of Excellence GR-EX, Paris, France.,Institute of Universities of France, Paris, France
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12
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Naik RP, Smith-Whitley K, Hassell KL, Umeh NI, de Montalembert M, Sahota P, Haywood C, Jenkins J, Lloyd-Puryear MA, Joiner CH, Bonham VL, Kato GJ. Clinical Outcomes Associated With Sickle Cell Trait: A Systematic Review. Ann Intern Med 2018; 169:619-627. [PMID: 30383109 PMCID: PMC6487193 DOI: 10.7326/m18-1161] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Although sickle cell trait (SCT) is largely a benign carrier state, it may increase risk for certain clinical outcomes. Purpose To evaluate associations between SCT and clinical outcomes in children and adults. Data Sources English-language searches of PubMed, CINAHL, the Cochrane Library, Current Contents Connect, Scopus, and Embase (1 January 1970 to 30 June 2018) and bibliographies of review articles. Study Selection Observational controlled studies (published in English) in children or adults that examined an association between SCT and any of 24 clinical outcomes specified a priori in the following 6 categories: exertion-related injury; renal, vascular, pediatric, and surgery- or trauma-related outcomes; and overall mortality. Data Extraction A single reviewer extracted study data, which was checked by another; 2 reviewers independently assessed study quality; and strength of evidence was assessed by consensus. Data Synthesis Of 7083 screened studies, 41 met inclusion criteria. High-strength evidence supported a positive association between SCT and risk for pulmonary embolism, proteinuria, and chronic kidney disease. Moderate-strength evidence supported a positive association between SCT and exertional rhabdomyolysis and a null association between SCT and deep venous thrombosis, heart failure or cardiomyopathy, stroke, and pediatric height or weight. Absolute risks for thromboembolism and rhabdomyolysis were small. For the remaining 15 clinical outcomes, data were insufficient or strength of evidence was low. Limitation Publication bias was possible, and high-quality evidence was scant. Conclusion Sickle cell trait is a risk factor for a few adverse health outcomes, such as pulmonary embolism, kidney disease, and exertional rhabdomyolysis, but does not seem to be associated with such complications as heart failure and stroke. Insufficient data or low-strength evidence exists for most speculated complications of SCT. Primary Funding Source National Human Genome Research Institute.
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Affiliation(s)
| | - Kim Smith-Whitley
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | | | - Nkeiruka I. Umeh
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | - Puneet Sahota
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | - Carlton Haywood
- University of Pennsylvania, Philadelphia, Pennsylvania; Johns
Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - Jean Jenkins
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | | | - Vence L. Bonham
- National Human Genome Research Institute of the National
Institutes of Health, Bethesda, Maryland
| | - Gregory J. Kato
- Vascular Medicine Institute at the University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania
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13
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Sickle Cell Trait from a Metabolic, Renal, and Vascular Perspective: Linking History, Knowledge, and Health. J Racial Ethn Health Disparities 2016; 2:330-5. [PMID: 26322267 DOI: 10.1007/s40615-014-0077-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sickle cell trait (SCT) is at the intersection of genetics, social policy, and medicine. SCT occurs in three-hundred million people worldwide and in approximately 8 % of African-Americans. There has been great debate about the influence of SCT on health. Yet data exist, albeit controversial, which suggest that SCT is associated with metabolic derangements that can lead to sudden death after vigorous physical activity, renal dysfunction, thromboembolic events, and stroke. In addition, it has even been postulated that SCT might enhance the vascular complications of diabetes. This review focuses on (a) the scientific breakthroughs that led to the discovery of hemoglobin S, sickle cell disease, and SCT, (b) the history of screening programs in the United States, (c) the incidence and etiology of exercise-related sudden death in military personnel and athletes with SCT, and (d) the data examining the potential chronic disease consequences of SCT from a metabolic, renal, and vascular perspective.
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14
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Diaw M, Pialoux V, Martin C, Samb A, Diop S, Faes C, Mury P, Sall Diop N, Diop SN, Ranque B, Mbaye MN, Key NS, Connes P. Sickle Cell Trait Worsens Oxidative Stress, Abnormal Blood Rheology, and Vascular Dysfunction in Type 2 Diabetes. Diabetes Care 2015; 38:2120-7. [PMID: 26324331 PMCID: PMC4613921 DOI: 10.2337/dc15-0699] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/04/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It is predicted that Africa will have the greatest increase in the number of patients with type 2 diabetes mellitus (T2DM) within the next decade. T2DM patients are at risk for cardiovascular disorders. In Sub-Saharan African countries, sickle cell trait (SCT) is frequent. Despite the presence of modest abnormalities in hemorheology and oxidative stress, SCT is generally considered a benign condition. Little is known about vascular function in SCT, although recent studies demonstrated an increased risk of cardiovascular disorders, including venous thromboembolism, stroke, and chronic kidney disease. We hypothesized that SCT could accentuate the vascular dysfunction observed in T2DM. RESEARCH DESIGN AND METHODS The current study, conducted in Senegal, compared vascular function, hemorheological profile, and biomarkers of oxidative stress, inflammation, and nitric oxide metabolism in healthy individuals (CONT), subjects with T2DM or SCT, and patients with both T2DM and SCT (T2DM-SCT). RESULTS Flow-mediated dilation was blunted in individuals with T2DM, SCT, and T2DM-SCT compared with CONT, with vascular dysfunction being most pronounced in the latter group. Carotid-femoral pulse wave velocity measurements demonstrated increased arterial stiffness in T2DM-SCT. Oxidative stress, advanced glycation end products, and inflammation (interleukin-1β) were greater in patients with T2DM-SCT compared with the other groups. Blood viscosity was higher in individuals with TD2M, SCT carriers, and individuals with T2DM-SCT, and the values were further increased in the latter group. CONCLUSIONS Our results demonstrate severe biological abnormalities and marked vascular dysfunction in patients with both T2DM and SCT. SCT should be viewed as a risk factor for further cardiovascular disorders in individuals with T2DM.
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Affiliation(s)
- Mor Diaw
- Laboratoire de Physiologie et Explorations Fonctionnelles, FMPO, Université Cheikh Anta Diop de Dakar (UCAD), Dakar, Senegal
| | - Vincent Pialoux
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Institut Universitaire de France, Paris, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Cyril Martin
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Abdoulaye Samb
- Laboratoire de Physiologie et Explorations Fonctionnelles, FMPO, Université Cheikh Anta Diop de Dakar (UCAD), Dakar, Senegal UMI 3189, Environnement, Sante, Sociétés, CNRS, CNRST, Université Bamako-UCAD, Dakar, Senegal
| | - Saliou Diop
- Laboratoire d'Hémato-Immunologie, FMPO, UCAD, Dakar, Senegal
| | - Camille Faes
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Pauline Mury
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Niama Sall Diop
- Laboratoire de Biochimie et de Biologie Moléculaire, FMPO, UCAD, Dakar, Senegal
| | - Saïd-Norou Diop
- Clinique Médicale II, Centre Hospitalier Abass Ndao, Dakar, Senegal
| | - Brigitte Ranque
- Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France UMR INSERM 970, Université Paris Descartes, Paris, France Service de Médecine Interne, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Nigel S Key
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Philippe Connes
- CRIS EA 647 Laboratory, Team Vascular Biology and Red Blood Cell, University Claude Bernard Lyon 1, Villeurbanne, France Institut Universitaire de France, Paris, France Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
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15
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Mukendi K, Lepira FB, Makulo JR, Sumaili KE, Kayembe PK, Nseka MN. Sickle cell trait is not associated with chronic kidney disease in adult Congolese patients: a clinic-based, cross-sectional study. Cardiovasc J Afr 2015; 26:125-9. [PMID: 26592908 PMCID: PMC4538907 DOI: 10.5830/cvja-2014-076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 12/01/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the determinants of chronic kidney disease (CKD) with special emphasis on sickle cell trait (SCT). METHODS Three hundred and fifty-nine patients (171 men and 188 women), aged 18 years or older, with reduced kidney function (eGFR < 90 ml/min/1.73 m(2)) and seen at secondary and tertiary healthcare in Kinshasa were consecutively recruited in this cross-sectional study. Serum creatinine and haemoglobin electrophoresis were performed in each patient. CKD was defined as < 60 ml/min/1.73 m(2). Logistic regression analysis was used to assess determinants of CKD with a special emphasis on SCT. A p-value < 0.05 defined the level of statistical significance. RESULTS SCT was present in 19% of the study population; its frequency was 21 and 18% (p > 0.05) in patients with and without CKD, respectively. In multivariate analysis, sickle cell trait was not significantly (OR: 0.38; 95% CI: 0.559-1.839; p = 0.235) associated with CKD; the main determinants were dipstick proteinuria (OR: 1.86; 95% CI: 1.094-3.168; p = 0.02), the metabolic syndrome (OR: 1.69; 95% CI: 1.033-2.965; p = 0.03), haemoblobin ≥ 12 g/dl (OR: 0.36; 95% CI: 0.210-0.625; p = 0.001), and personal history of hypertension (OR: 2.16; 95% CI: 1.202-3.892; p = 0.01) and of diabetes mellitus (OR: 2.35; 95% CI: 1.150-4.454; p = 0.001). CONCLUSION SCT was not an independent determinant of CKD in the present case series. Traditional risk factors emerged as the main determinants of CKD.
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Affiliation(s)
- K Mukendi
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kinshasa Hospital, Kinshasa, Democratic Republic of Congo
| | - F B Lepira
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kinshasa Hospital, Kinshasa, Democratic Republic of Congo.
| | | | - K E Sumaili
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kinshasa Hospital, Kinshasa, Democratic Republic of Congo
| | - P K Kayembe
- School of Public Health/University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - M N Nseka
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kinshasa Hospital, Kinshasa, Democratic Republic of Congo
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16
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Key NS, Connes P, Derebail VK. Negative health implications of sickle cell trait in high income countries: from the football field to the laboratory. Br J Haematol 2015; 170:5-14. [PMID: 25754217 DOI: 10.1111/bjh.13363] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Worldwide, sickle cell trait is a highly prevalent gene carrier state. While generally a benign condition with a normal life expectancy, it is becoming increasingly clear that the sickle trait is associated with certain adverse outcomes. This article will focus on three of these outcomes, namely exertional rhabdomyolysis and sudden death, chronic renal dysfunction, and venous thromboembolism. In each case, the epidemiological evidence for the association is reviewed, together with the existing data on potential underlying mechanisms. Because newborn screening programmes for sickle cell anaemia also identify those with sickle cell trait, it is imperative that further studies determine what, if any, preventive measures can be taken to reduce the burden of these uncommon but potentially morbid complications in affected individuals.
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Affiliation(s)
- Nigel S Key
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philippe Connes
- Laboratoire CRIS EA647, Section 'Vascular Biology and Red Blood Cell', Université Claude Bernard Lyon 1, Lyon, France.,Institut Universitaire de France, Paris, France
| | - Vimal K Derebail
- Division of Nephrology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Abstract
Sickle cell disease (SCD) substantially alters renal structure and function, and causes various renal syndromes and diseases. Such diverse renal outcomes reflect the uniquely complex vascular pathobiology of SCD and the propensity of red blood cells to sickle in the renal medulla because of its hypoxic, acidotic, and hyperosmolar conditions. Renal complications and involvement in sickle cell nephropathy (SCN) include altered haemodynamics, hypertrophy, assorted glomerulopathies, chronic kidney disease, acute kidney injury, impaired urinary concentrating ability, distal nephron dysfunction, haematuria, and increased risks of urinary tract infections and renal medullary carcinoma. SCN largely reflects an underlying vasculopathy characterized by cortical hyperperfusion, medullary hypoperfusion, and an increased, stress-induced vasoconstrictive response. Renal involvement is usually more severe in homozygous disease (sickle cell anaemia, HbSS) than in compound heterozygous types of SCD (for example HbSC and HbSβ(+)-thalassaemia), and is typically mild, albeit prevalent, in the heterozygous state (sickle cell trait, HbAS). Renal involvement contributes substantially to the diminished life expectancy of patients with SCD, accounting for 16-18% of mortality. As improved clinical care promotes survival into adulthood, SCN imposes a growing burden on both individual health and health system costs. This Review addresses the renal manifestations of SCD and focuses on their underlying mechanisms.
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Affiliation(s)
- Karl A Nath
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street S. W., Rochester, MN 55905, USA
| | - Robert P Hebbel
- Division of Haematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Mayo Mail Code 480, 420 Delaware Street S. E., Minneapolis, MN 55455, USA
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18
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Derebail VK, Lacson EK, Kshirsagar AV, Key NS, Hogan SL, Hakim RM, Mooney A, Jani CM, Johnson C, Hu Y, Falk RJ, Lazarus JM. Sickle trait in African-American hemodialysis patients and higher erythropoiesis-stimulating agent dose. J Am Soc Nephrol 2014; 25:819-26. [PMID: 24459231 DOI: 10.1681/asn.2013060575] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
African Americans require higher doses of erythropoiesis-stimulating agents (ESAs) during dialysis to manage anemia, but the influence of sickle cell trait and other hemoglobinopathy traits on anemia in dialysis patients has not been adequately evaluated. We performed a cross-sectional study of a large cohort of adult African-American hemodialysis patients in the United States to determine the prevalence of hemoglobinopathy traits and quantify their influence on ESA dosing. Laboratory and clinical data were obtained over 6 months in 2011. Among 5319 African-American patients, 542 (10.2%) patients had sickle cell trait, and 129 (2.4%) patients had hemoglobin C trait; no other hemoglobinopathy traits were present. Sickle cell trait was more common in this cohort than the general African-American population (10.2% versus 6.5%-8.7%, respectively, P<0.05). Among 5002 patients (10.3% sickle cell trait and 2.4% hemoglobin C trait) receiving ESAs, demographic and clinical variables were similar across groups, with achieved hemoglobin levels being nearly identical. Patients with hemoglobinopathy traits received higher median doses of ESA than patients with normal hemoglobin (4737.4 versus 4364.1 units/treatment, respectively, P=0.02). In multivariable analyses, hemoglobinopathy traits associated with 13.2% more ESA per treatment (P=0.001). Within subgroups, sickle cell trait patients received 13.2% (P=0.003) higher dose and hemoglobin C trait patients exhibited a similar difference (12.9%, P=0.12). Sensitivity analyses using weight-based dosing definitions and separate logistic regression models showed comparable associations. Our findings suggest that the presence of sickle cell trait and hemoglobin C trait may explain, at least in part, prior observations of greater ESA doses administered to African-American dialysis patients relative to Caucasian patients.
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19
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Hsieh YY, Huang YC, Chang CC, Wang YK, Lin WH, Tsai FJ. Chromosome 15q21-22-related polymorphisms and haplotypes are associated with susceptibility to type-2 diabetic nonproliferative retinopathy. Genet Test Mol Biomarkers 2012; 16:442-8. [PMID: 22409602 DOI: 10.1089/gtmb.2011.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Diabetic retinopathy (DR) is a microvascular complication of diabetes with a complex multifactorial pathogenesis. We aimed to investigate whether chromosome 15q21-22-related gene polymorphisms could be used as markers of DR susceptibility in type 2 diabetic (T2D) individuals. METHODS Individuals were divided into three groups: (1) T2D with nonproliferative DR (NPDR; n=102); (2) T2D with proliferative DR (PDR; n=72); (3) T2D without DR (n=573). Six single-nucleotide polymorphisms (SNPs) (rs7174997, rs3751624, rs8025011, rs17818837, rs2922220, and rs2414520) lying within chromosome 15q21-22 region were genotyped by using Illumina HumanHap550-Duo BeadChips. Genotypes/allelic frequencies and haplotypes for these polymorphisms in each group were compared. RESULTS The MYO5C related SNP (rs3751624)*A related genotype and allele are associated with higher susceptibilities to DR, including PDR and NPDR. The rs3751624*GG/AA+AG percentages in each group are (1) 75.5%/24.5%, (2) 73.6%/26.4%, and (3) 82.5%/17.5%. In contrast, the other five SNPs in each group were not significantly different. One haplotype (G-A-G-G-T-G) appears significantly different between T2D individuals with and without DR. Other haplotype distributions were not significantly different between each group. CONCLUSION The MYO5C related SNP (rs3751624)*A related genotype/allele and haplotype (G-A-G-G-T-G) might be associated with susceptibility for retinopathy in T2D individuals. Some chromosome 15q21-22* related genetic variations might contribute to the pathogenesis of DR.
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Affiliation(s)
- Yao-Yuan Hsieh
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Goldsmith JC, Bonham VL, Joiner CH, Kato GJ, Noonan AS, Steinberg MH. Framing the research agenda for sickle cell trait: building on the current understanding of clinical events and their potential implications. Am J Hematol 2012; 87:340-6. [PMID: 22307997 PMCID: PMC3513289 DOI: 10.1002/ajh.22271] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 12/01/2011] [Indexed: 02/02/2023]
Abstract
Sickle Cell Trait (HbAS), the heterozygous state for the sickle hemoglobin beta globin gene is carried by as many as 100 million individuals including up to 25% of the population in some regions of the world (World Health Organization, Provisional agenda item 4.8, EB117/34 (22 December 2005) or World Health Organization, Provisional agenda item 11.4 (24 April 2006)). Persons with HbAS have some resistance to falciparum malaria infection in early childhood (Piel FB, Patil AP, Howes RE, et al., Nat Commun 2010;1104:1-7 and Aidoo M, Terlouw DJ, Kolczak M, et al., Lancet 2002;359:1311-1312) and as a result individuals with HbAS living in malarial endemic regions of Africa have a survival advantage over individuals with HbAA. Reports from the US emphasize possible health risks for individuals with HbAS including increased incidence of renal failure and malignancy, thromboembolic disorders, splenic infarction as a high altitude complication, and exercise-related sudden death. The National Heart, Lung, and Blood Institute, National Institutes of Health convened a workshop in Bethesda, Maryland on June 3-4, 2010, Framing the Research Agenda for Sickle Cell Trait, to review the clinical manifestations of HbAS, discuss the exercise-related sudden death reports in HbAS, and examine the public health, societal, and ethical implications of policies regarding HbAS. The goal of the workshop was to identify potential research questions to address knowledge gaps.
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Affiliation(s)
- Jonathan C Goldsmith
- Blood Diseases Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-7950, USA.
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Sickle cell trait is not independently associated with susceptibility to end-stage renal disease in African Americans. Kidney Int 2011; 80:1339-43. [PMID: 21849968 DOI: 10.1038/ki.2011.286] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Conflicting reports exist as to whether sickle cell trait is a risk factor for the progression of nephropathy. In order to determine whether African Americans with sickle cell trait are at increased risk for kidney disease, we assessed the genetic association between sickle cell trait and end-stage renal disease (ESRD). Hemoglobin S, non-muscle myosin heavy chain 9 (MYH9), and apolipoprotein L1 (APOL1) risk variants were genotyped in 3258 unrelated African Americans: 1085 with non-diabetic ESRD, 996 with type 2 diabetes-associated ESRD, and 1177 controls. Since APOL1 is strongly associated with ESRD in African Americans, interactions between APOL1 and MYH9 risk variants and hemoglobin S were assessed using case-only and case-control centered two-way logistic regression interaction analyses. The sickle cell trait genotype frequencies were 8.7% in non-diabetic ESRD, 7.1% in type 2 diabetes-ESRD, and 7.2% in controls. There was no age-, gender-, and admixture-adjusted significance for sickle cell trait association with non-diabetic ESRD (odds ratio 1.16); type 2 diabetes-ESRD (odds ratio 1.01); or all-cause ESRD (combined non-diabetic and type 2 diabetic-ESRD patients compared to the controls; odds ratio 1.05) in dominant models. In addition, no evidence of APOL1 or MYH9 interactions with sickle cell trait was detected. Hence, sickle cell trait is not associated with diabetic or non-diabetic ESRD in a large sample of African Americans.
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Shaw C, Sharpe CC. Could sickle cell trait be a predisposing risk factor for CKD? Nephrol Dial Transplant 2010; 25:2403-5. [PMID: 20392705 DOI: 10.1093/ndt/gfq186] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Derebail VK, Nachman PH, Key NS, Ansede H, Falk RJ, Kshirsagar AV. High prevalence of sickle cell trait in African Americans with ESRD. J Am Soc Nephrol 2010; 21:413-7. [PMID: 20056747 DOI: 10.1681/asn.2009070705] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Sickle cell trait (HbAS) associates with impaired urinary concentration, hematuria, and renal papillary necrosis, but its prevalence among African Americans with ESRD is unknown. We performed a cross-sectional study reviewing available hemoglobin phenotypes for 188 of 206 adult African-American patients receiving renal replacement therapy in four dialysis units. Results from the state newborn screening program in corresponding counties provided the local population prevalence of sickle trait among African Americans. Compared with the general African-American population, HbAS was twice as common among African Americans with ESRD (15% versus 7%, P < 0.001). Prevalence of hemoglobin C trait (HbAC) was similarly more common (5% versus 2%, P < 0.01). The higher prevalence of HbAS and HbAC in the ESRD population raises the possibility that these hemoglobinopathies contribute to a decline in kidney function, either alone or in conjunction with other known risk factors for renal disease. The potential effect of HbAS on the development and progression of CKD and its effect on the course and management of patients with ESRD deserve further study.
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Affiliation(s)
- Vimal K Derebail
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7155, USA.
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Key NS, Derebail VK. Sickle-cell trait: novel clinical significance. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2010; 2010:418-22. [PMID: 21239829 PMCID: PMC3299004 DOI: 10.1182/asheducation-2010.1.418] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
There is a long-standing controversy in the literature as to whether sickle-cell trait (SCT) should be viewed as a benign carrier state or as an intermediate disease phenotype. Because SCT is routinely detected by neonatal screening for sickle-cell disease, it becomes imperative that consensus on this issue be achieved in order to provide the best medical advice to affected individuals. The issue of selective screening in the post-neonatal period was thrust into the limelight recently by the National Collegiate Athletic Association's recommendation that its member colleges and universities test student-athletes to confirm their carrier status if not already known. The stated goal of this recommendation was to prevent exercise-related sudden death in athletes with SCT. We review some of the reported complications of SCT for which new information has emerged, focusing particularly on venous thromboembolism and renal manifestations.
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Affiliation(s)
- Nigel S Key
- Division of Hematology/Oncology, UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
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Huh J, Prause JA, Dooley CD. The impact of nativity on chronic diseases, self-rated health and comorbidity status of Asian and Hispanic immigrants. J Immigr Minor Health 2008; 10:103-18. [PMID: 17546500 DOI: 10.1007/s10903-007-9065-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examines the physical health status of immigrants with specific considerations of Asian and Hispanic populations and explores possible mechanisms through which health outcomes of interest can be explained. Analyses of the National Health Interview Surveys (NHIS) of 2000 and 2001 revealed that foreign-born individuals reported fewer chronic diseases (hypertension, heart disease, asthma, cancer and diabetes) and had lower prevalences of various chronic diseases compared with U.S.-born whites, controlling for possible confounders and mediators. However, U.S-born minority groups did not show the health advantage seen in foreign-born immigrants, reflecting the importance of nativity distinctions in studying immigrant health. Despite having fewer chronic diseases, foreign-born Asians were more likely to rate their health negatively relative to their U.S.-born counterparts and to U.S.-born whites. In addition, our findings provide evidence that failure to consider comorbid status may attenuate the nativity effect on certain chronic diseases.
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Affiliation(s)
- Jimi Huh
- Department of Psychology and Social Behavior, University of California at Irvine, 3340 Social Ecology Building II, Irvine, CA 92697-7085, USA.
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Connes P, Reid H, Hardy-Dessources MD, Morrison E, Hue O. Physiological Responses of Sickle Cell Trait Carriers during Exercise. Sports Med 2008; 38:931-46. [DOI: 10.2165/00007256-200838110-00004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Le Gallais D, Lonsdorfer J, Bogui P, Fattoum S. Last Word on Point:Counterpoint “Sickle cell trait should/should not be considered asymptomatic and as a benign condition during physical activity”. J Appl Physiol (1985) 2007. [DOI: 10.1152/japplphysiol.00981.2007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
OBJECTIVE To determine if the time courses of hemorheologic parameters are different between carriers of sickle cell trait (SCT) and subjects with normal hemoglobin in response to exercise. DESIGN Observational and comparative study. SETTING Testing was conducted in a laboratory of exercise physiology. PARTICIPANTS Nine carriers of sickle cell trait (SCT group) and 7 subjects with normal hemoglobin (CONT group) performed an exercise protocol of the repetition of 3 successive maximal ramp exercise tests. INTERVENTIONS Blood was sampled at rest (TR), at the end of each of the 3 tests (T1, T2, T3), and during the immediate (T2h) and late (T24h, T48h) recovery periods. MAIN OUTCOME MEASUREMENTS Blood and plasma viscosity (etab and etap, respectively), hematocrit (Hct), and red blood cell (RBC) rigidity (Tk and k indexes) were determined. RESULTS In both groups, etab significantly increased in response to exercise but the SCT group had significantly higher etab at T3 and T2h. etab then returned to baseline value at T2h in the CONT group and at T24h in the SCT group. Tk and k were not changed by exercise but significantly increased above baseline value in both groups at T24h and T48h. The increase in Tk and k during late recovery was higher in the SCT group than in the CONT group, indicating that SCT carriers had significantly higher RBC rigidity than the CONT group at that time. CONCLUSIONS The hemorheologic changes induced by exercise in the SCT carriers could trigger microcirculatory disorders during the recovery.
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Bencaiova G, Krafft A, Zimmermann R. Is the sickle cell trait a risk factor in patients with type 2 diabetes mellitus? Eur J Intern Med 2005; 16:462. [PMID: 16198914 DOI: 10.1016/j.ejim.2005.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Revised: 02/03/2005] [Accepted: 02/03/2005] [Indexed: 11/19/2022]
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Ajayi AAL. Should the sickle cell trait be reclassified as a disease state? Eur J Intern Med 2005; 16:463. [PMID: 16198915 DOI: 10.1016/j.ejim.2005.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Revised: 02/15/2005] [Accepted: 02/28/2005] [Indexed: 10/25/2022]
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Ajayi AAL. Gender influences the impact of sickle cell trait on Type 2 diabetic complications. Diabet Med 2005; 22:954. [PMID: 15975116 DOI: 10.1111/j.1464-5491.2005.01445.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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