Coronary Artery Calcification in Hemophilia A

Abstract

Objective-Ischemic heart disease mortality is lower in hemophilia patients than in the general male population. As coagulation plays a role in the inflammatory pathways involved in atherogenesis, we investigated whether the clotting factor deficiency protects hemophilia patients from developing atherosclerosis. Methods and Results-Coronary artery calcification, measured with multidetector-row computed tomography, was compared between 42 men, Ն59 years, with severe or moderate hemophilia A, and 613 nonhemophilic men from the Rotterdam Study, a prospective population-based study. None of the study subjects were HIV infected or had a history of cardiovascular disease. Coronary artery calcification was quantified by calculating the Agatston score and calcification mass. Data were analyzed using linear regression. Mean difference (␤) of the natural log-transformed Agatston score between men with and without hemophilia was 0.

Is a decrease of microparticles related to improvement of hemostasis after FVIII injection in hemophilia A patients treated on demand?

“…At least two directions for further investigation to define the role of MPs in hemophilia A may be drawn from the present work: (i) transient increases in circulating MP counts may be a safe possibility for the improvement of hemostatic status in hemophilia A and therefore there may be some therapeutic opportunities [24]; (ii) knowing the role of MPs in atherothrombosis and the facts that hemophilia is not considered protective against thrombosis [25,26] and that infusion of FVIII or by-pass agents may potentially precipitate a thrombotic event [27], it would be of particular importance to define the role of MPs in hemophilia A.…”

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

“…10 Another study found a similar degree of coronary calcium deposition and severe calcification in patients with hemophilia aged 59 years or older compared with matched controls without hemophilia. 11 Although hemophilia does not seem to protect against the development of atherosclerosis, several studies suggest that it may protect against mortality from IHD.…”

Cardiovascular risk in patients with hemophilia

“…Finally, subclinical atherosclerosis was analyzed by coronary artery calcification with multidetector-row computed tomography in 42 men, $59 years, with severe or moderate hemophilia A (factor VIII ,5%) and 613 nonhemophilic men. 30 None of the subjects had a history of CVD and mean age of the study population was 66.5 years. The results showed that 24% of the subjects in both groups had severe calcification of the coronary arteries, despite the fact that patients had severe or moderate hemophilia, which again challenges the protective effect of factor VIII deficiency on the development of atherosclerosis.…”