Sickle cell trait and sudden death in athletes

In Reply. —Drs Kerle and Runkle have made a reasonable point regarding the potential role that sickle cell trait may have played in the sudden deaths of young African-American athletes with cardiovascular disease in our study population. As Kerle and Runkle point out, sickle cell trait has been incriminated as a sole determinant of sudden cardiac death with exertion,1,2and indeed, 1 of our athletes without a detectable cardiac abnormality had only the finding of sickle trait to explain sudden death. Among the 134 competitive athletes in our study, we found hypertrophic cardiomyopathy to be the most common cause of sudden death. Of the 48 athletes assigned this diagnosis at autopsy, the majority were black. Unfortunately, our study design did not include a systematic analysis for sickle cell trait in these individuals. Also, we encountered 14 other athletes who showed an increase in left ventricular mass, but no other features of