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      A cross-sectional analysis of cardiovascular disease in the hemophilia population

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          Key Points

          • CV risk factors are common in older men with hemophilia.

          • Although older men with hemophilia have less CV disease than comparable unaffected men, CV events do occur and require treatment.


          Men with hemophilia were initially thought to be protected from cardiovascular disease (CVD), but it is now clear that atherothrombotic events occur. The primary objective of the CVD in Hemophilia study was to determine the prevalence of CVD and CVD risk factors in US older men with moderate and severe hemophilia and to compare findings with those reported in age-comparable men in the Atherosclerosis Risk in Communities (ARIC) cohort. We hypothesized if lower factor levels are protective from CVD, we would see a difference in CVD rates between more severely affected and unaffected men. Beginning in October 2012, 200 patients with moderate or severe hemophilia A or B (factor VIII or IX level ≤ 5%), aged 54 to 73 years, were enrolled at 19 US hemophilia treatment centers. Data were collected from patient interview and medical records. A fasting blood sample and electrocardiogram (ECG) were obtained and assayed and read centrally. CVD was defined as any angina, any myocardial infarction by ECG or physician diagnosis, any self-reported nonhemorrhagic stroke or transient ischemic attack verified by physicians, or any history of coronary bypass graft surgery or coronary artery angioplasty. CVD risk factors were common in the population. Compared with men of similar age in the ARIC cohort, patients with hemophilia had significantly less CVD (15% vs 25.8%; P < .001). However, on an individual patient level, CVD events occur and efforts to prevent cardiovascular events are warranted. Few men were receiving secondary prophylaxis with low-dose aspirin, despite published opinion that it can be used safely in this patient population.

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          Author and article information

          Blood Adv
          Blood Adv
          Blood Adv
          Blood Advances
          Blood Advances
          American Society of Hematology (Washington, DC )
          12 June 2018
          12 June 2018
          12 June 2018
          : 2
          : 11
          : 1325-1333
          [1 ]Department of Internal Medicine, University of Michigan, Ann Arbor, MI;
          [2 ]American Thrombosis and Hemostasis Network, Chicago, IL;
          [3 ]Department of Medicine, University of Pittsburgh, Pittsburgh, PA;
          [4 ]Department of Medicine, Georgetown University, Washington, DC;
          [5 ]Orthopedic Hospital, Los Angeles, CA;
          [6 ]Indiana Hemophilia and Thrombosis Center, Indianapolis, IN;
          [7 ]Department of Medicine, University of North Carolina, Chapel Hill, NC;
          [8 ]Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO;
          [9 ]Department of Medicine, University of Pennsylvania, Philadelphia, PA;
          [10 ]Departments of Medicine and Pediatrics, Emory University, Atlanta, GA;
          [11 ]Department of Medicine, The Ohio State University, Columbus, OH;
          [12 ]Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA;
          [13 ]Department of Medicine, Henry Ford Hospital, Detroit, MI;
          [14 ]Department of Medicine, University of California, San Diego, CA;
          [15 ]Blood Center of Wisconsin, Milwaukee, WI;
          [16 ]Department of Medicine, Vanderbilt University, Nashville, TN;
          [17 ]Mary M. Gooley Hemophilia Center, Rochester, NY;
          [18 ]Department of Medicine, University of Texas Health Science Center and McGovern Medical School, Houston, TX;
          [19 ]Department of Medicine, Tulane University, New Orleans, LA;
          [20 ]Bloodworks Northwest, Seattle, WA; and
          [21 ]Department of Medicine, University of Washington, Seattle, WA
          PMC5998925 PMC5998925 5998925 2018/018226
          © 2018 by The American Society of Hematology
          Page count
          Pages: 9
          Thrombosis and Hemostasis
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