Cardiovascular disease risk factors

Abstract

With increasing longevity, the prevalence of cardiovascular disease (CVD) risk factors in hemophilia patients is expected to increase; however, evidence-based guidelines on management are lacking. The aim of the study was to determine the prevalence and management of CVD risk factors in hemophilia patients. A retrospective study of 58 adult hemophilia patients (≥35 years) attending Mayo Comprehensive Hemophilia Center between 1 January 2006 and 15 October 2009 were reviewed. The prevalence of CVD risk factors was hypertension 65.5%, diabetes 10.3%, smoking 12.5% and obesity 19.6%. A total of 31% did not have a lipid profile on record. Management of risk factors included antihypertensive medications in 84.2% and lipid-lowering agents in 12.1%. During their medical evaluation, four of seven active smokers received smoking cessation counseling and four of 11 obese patients received lifestyle modification advice. Eight patients (13.8%) experienced a CVD event: myocardial infarction (MI) (n=3), coronary artery disease (n=2), both MI and ischemic stroke (n=1) and hemorrhagic strokes (n=2). Only five of eight patients were on low-dose aspirin, of which aspirin was discontinued in one patient after he was diagnosed with hemophilia following a bleeding work-up. Another patient on dual antiplatelet therapy post stent placement developed epistaxis resulting in clopidogrel cessation. Hemophilia patients are at risk for CVD, similar to the general age-matched male population. Screening for CVD risk factors, with preventive dietary and pharmacologic interventions, play a key role in the prevention and long-term management of CVD. Collaborative efforts between primary care providers, cardiologists and hemophilia center specialists remain essential in managing these complex patients.

Epidemiology of Hereditary Coagulation Bleeding Disorders: A 15-Year Experience From Southern Iran

“…14 In their study of a US population aged more than 35 years old with hemophilia, Lim and Pruthi found that the prevalence rates of hypertension and diabetes were 65.5% and 10.3%, respectively. 7 The prevalence rates of diabetes and hypertension in the current study (1.3% and 0.2%, respectively) were less than that reported in other studies, which may be due to the younger population of study (mostly below 40 years of age).…”

Consensus Review of the Treatment of Cardiovascular Disease in People With Hemophilia A and B

“…PWH are susceptible to the same cardiovascular risk factors as individuals without hemophilia, and even more so to certain traditional risk factors such as hypertension 15 , 24 – 26 and obesity related to limited mobility from arthropathy. 18 , 27 In a cohort of more than 700 PWH from the Netherlands and United Kingdom, the predicted 10-year risk of fatal MI or stroke was significantly higher (8.9%) than in the general population (6.7%), based solely on typical factors determining cardiovascular risk (including age, blood pressure, total/high-density lipoprotein cholesterol, body mass index, and smoking or DM history).…”

“…Data suggest that screening and intervention for these traditional risk factors are currently suboptimal in PWH. 26 Aggressive management of individual cardiovascular risk factors with appropriate medications and lifestyle modifications may allow for deferment of invasive interventions and antiplatelet medications in PWH with symptomatic CAD, especially those with inhibitors. 78 Whether the benefits of low-dose aspirin prophylaxis for cardiovascular events outweigh the potential risk for bleeding in PWH is uncertain.…”

A second retrospective database analysis confirms prior findings of apparent increased cardiovascular comorbidities in hemophilia A in the United States

“…Some studies have reported lower mortality from CV diseases and/or decreased atherogenesis in patients with hemophilia because of the potentially protective effect of chronically low factor VIII (FVIII) activity on thrombus formation 2, 3. Conversely, other reports indicate comparable or higher CV comorbidities in patients with hemophilia compared with the general population 4, 5, 6. One such study specifically assessed the CV risk profile (via QRISK®2) of 709 patients aged ≥30 years in the Netherlands or United Kingdom 5.…”