Prevalence and risk factors of cardiovascular disease (CVD) events among patients with haemophilia: experience of a single haemophilia treatment centre in the United States (US)

Abstract

The primary objective of the study was to examine the prevalence of cardiovascular disease (CVD) events and their known risk factors among persons with haemophilia (PWH). This cross-sectional study, covering a 5-year period, included PWH aged ≥35 years who were cared for at a single haemophilia treatment centre in the United States. Medical records were extensively reviewed to collect the information about CVD events and their risk factors such as obesity, hypertension, diabetes, hypercholesterolemia and smoking. Prevalence rates were compared with national population estimates and associations between risk factors and CVD events were examined using logistic regression. The study cohort comprised 185 PWH (102 haemophilia A and 83 haemophilia B). Lifetime prevalence of a CVD event was 19.5% (36/185, 95% confidence interval [CI] 13.8-25.2%). CVD mortality was 5.4% (10/185, 95% CI 2.7-8.1). Compared with US non-Hispanic White males (NHWH), PWH had about twice the prevalence of coronary artery disease, stroke and myocardial infarction. The prevalence of CVD risk factors for PWH was similar to that for US NHWM with 39.5% of PWH exposed to two or more of these risk factors. Both hypertension and smoking were associated significantly with CVD events, with odds ratios of 4.9 and 6.3, respectively. In conclusion, this study revealed that both CVD events and its risk factors were at least equally prevalent among PWH and might have been even higher than among the US NHWM in the United States. Therefore, it is imperative to implement strategies for CVD prevention among PWH.

Arterial and Venous Thrombosis in Haemophilia Patients: Experiences from a Danish Haemophilia Centre

“…The retinal events could not be classified with certainty as arterial or venous. Thus, the prevalence of cardiovascular disease (CVD) was 5%, which is comparable to previous studies which report a life-time prevalence of CVD of 3-20% in PWH [2,4,6,15]. The most common risk factors were hypertension ( n = 8) and hypercholesterolaemia ( n = 7).…”

“…The prevalence of cardiovascular disease (CVD) in PWH has been investigated in several studies [1,2,3,4,5,6,7] and varies from <2% to 20% between studies, depending on age and the severity of the haemophilia. Thus, it is difficult to estimate the exact magnitude of the problem; however, there is agreement that CVD occurs in PWH, especially in older patients or those with ≥1 CVD risk factors, and it can pose a serious problem [8,9].…”

The Hypertension of Hemophilia Is Not Explained by the Usual Cardiovascular Risk Factors: Results of a Cohort Study

“…However, the converse was the case: PWH weighed less and had lower serum cholesterol, their serum creatinine levels and eGFR levels showed better kidney function, and they had lower rates of diabetes and smoking. Others have also found PWH to have better weight and cholesterol profiles [5, 26, 27], although one large study of PWH also noted that their diabetes and smoking rates were similar to the general population [26]. …”

How I treat patients with inherited bleeding disorders who need anticoagulant therapy

“…One such comorbidity is cardiovascular disease (CVD). The lifetime prevalence of CVD has been estimated to be as high as 19.5% in persons with hemophilia, 2 and the prevalence of ischemic heart disease (IHD) is estimated to be 15% in those older than 60 years. 3 Published literature demonstrates that CVD and arterial occlusive events occur in VWD as well, albeit at a reduced prevalence compared with reference populations: the rate of arterial thrombotic events was found to be 3.3% in a cohort study of more than 600 adult VWD patients, significantly lower than 2 reference populations, 4 and the prevalence of CVD was found to be 15% in a cross-sectional study of more than 7500 patients with VWD, compared with 26% in non-VWD patients.…”