BACKGROUND:
Vascular Ehlers-Danlos syndrome (vEDS) is a rare connective tissue disorder with a high risk for arterial, bowel, and uterine rupture, caused by heterozygous pathogenic variants in
COL3A1
. The aim of this cohort study is to provide further insights into the natural history of vEDS and describe genotype-phenotype correlations in a Dutch multicenter cohort to optimize patient care and increase awareness of the disease.
METHODS:
Individuals with vEDS throughout the Netherlands were included. The phenotype was charted by retrospective analysis of molecular and clinical data, combined with a one-time physical examination.
RESULTS:
A total of 142 individuals (50% female) participated the study, including 46 index patients (32%). The overall median age at genetic diagnosis was 41.0 years. More than half of the index patients (54.3%) and relatives (53.1%) had a physical appearance highly suggestive of vEDS. In these individuals, major events were not more frequent (
P
=0.90), but occurred at a younger age (
P
=0.01). A major event occurred more often and at a younger age in men compared with women (
P
<0.001 and
P
=0.004, respectively). Aortic aneurysms (
P
=0.003) and pneumothoraces (
P
=0.029) were more frequent in men. Aortic dissection was more frequent in individuals with a
COL3A1
variant in the first quarter of the collagen helical domain (
P
=0.03).
CONCLUSIONS:
Male sex, type and location of the
COL3A1
variant, and physical appearance highly suggestive of vEDS are risk factors for the occurrence and/or early age of onset of major events. This national multicenter cohort study of Dutch individuals with vEDS provides a valuable basis for improving guidelines for the diagnosing, follow-up, and treatment of individuals with vEDS.