Cardiovascular comorbidities are increased in US patients with haemophilia A: a retrospective database analysis

Abstract

There is conflicting evidence in the literature on whether individuals with haemophilia in the USA have greater, reduced, or similar risks for cardiovascular disease as the general population. This study evaluated the prevalence of cardiovascular comorbidities among USA males with haemophilia A, relative to an unaffected general male population with similar characteristics. Males with haemophilia A and continuous insurance coverage were identified by ICD-9-CM code 286.0 (1 January 2007-31 December 2009) using the MarketScan Commercial and Medicare Research Databases. Individuals with haemophilia A were exact matched 1:3 with males without a diagnosis of haemophilia A. The prevalence of cardiovascular comorbidities identified by ICD-9-CM code was determined for matched cohorts. Of the study population, 2506 were grouped in the haemophilia A cohort and 7518 in the general cohort. Proportions of individuals with haemorrhagic stroke (2.0% vs. 0.5%, P < 0.001), ischemic stroke (4.7% vs. 2.7%, P < 0.001), coronary artery disease (10.7% vs. 5.8%, P < 0.001), myocardial infarction (0.8% vs. 0.3%, P = 0.003), hypertension (22.6% vs. 15.5%, P < 0.001), hyperlipidaemia (15.9% vs. 11.9%, P < 0.001), arterial thrombosis (12.1% vs. 5.9%, P < 0.001), and venous thrombosis (4.4% vs. 1.1%, P < 0.001) were significantly greater for the haemophilia A cohort. Results were consistent across most age groups, and comorbidities appeared at an earlier age in those with haemophilia A than in the general population. Among the USA haemophilia A population cardiovascular comorbidities are more prevalent and they appear earlier in life in comparison to the general male population, suggesting the need for earlier, enhanced screening for age-related comorbidities in the haemophilia community.

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

“…Across age groups, more patients had venous access devices than controls (4.19% vs. 0.38%). The between‐cohort differences obtained using the PharMetrics database analysis were similar to those in the previously published MarketScan database analysis 1.…”

“…Data for that study were derived from the MarketScan® Commercial and Medical Research databases (Ann Arbor, MI), from January 1, 2007 to December 31, 2009. The prevalence of CV comorbidities including hemorrhagic stroke, ischemic stroke, arterial thrombosis, and venous thrombosis was statistically significantly higher in the hemophilia A cohort compared with the control population of patients without hemophilia 1. Moreover, CV comorbidities showed earlier onset in hemophilia A versus the general patient population.…”

“…The availability of replacement factor products and improvements in treatment strategies over time have led to increased life expectancy of patients with hemophilia; consequently, the incidence of age‐related comorbidities has increased in this population 1, 2. There have been conflicting published data regarding the risks of cardiovascular (CV) comorbidities in patients with hemophilia compared with the general population.…”

“…We previously conducted a retrospective claims database analysis showing a higher prevalence of CV comorbidities in male patients with hemophilia compared with a general male population with similar patient characteristics 1. Data for that study were derived from the MarketScan® Commercial and Medical Research databases (Ann Arbor, MI), from January 1, 2007 to December 31, 2009.…”

“…The structure of the study cohorts and the inclusion criteria were similar to those used previously in the MarketScan database analysis 1. The presence of hemophilia A was determined by an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) code of 286.0 for ≥1 inpatient discharge diagnosis or ≥2 primary or secondary outpatient claims on two different dates.…”