To the Editor.
—In their timely study on sudden death in athletes, Dr Maron and colleagues1 highlight hypertrophic cardiomyopathy as the major cause of sudden death in athletes younger than 35 years. However, we are concerned that the association between sudden death and sickle cell trait2 has not been adequately addressed in this article.The authors briefly mention 1 case of sudden death due to sickle cell trait. However, it is unclear how many of the 58 other black athletes in the series were sickle trait positive and how many were tested for the presence of hemoglobin AS. Because the association between sickle cell trait and sudden death is not widely appreciated, sickle cell trait may have been overlooked as an etiologic factor in the sudden death of several of these athletes.The prevalence of sickle cell trait is known to be 8% in the black population.3
Kerle KK, Runkle GP. Sickle Cell Trait and Sudden Death in Athletes. JAMA. 1996;276(18):1472. doi:10.1001/jama.1996.03540180028023