PB0663 - Risk Factors for Atherosclerosis in Patients with Hemophilia

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Alessandro Ciavarella, MD (he/him/his)

Specialized Doctor
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi
Milan, Lombardia, Italy

Co-Author(s)

FT

Francesco Tafuri

MD
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi
Milan, Lombardia, Italy
FB

Federico Boggio

Resident in Internal Medicine
Università degli Studi di Milano
Milan, Lombardia, Italy
Maria Abbattista, PhD

Clinical Researcher
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi
Milan, Lombardia, Italy
Sara Arcudi, MD

Academic researcher, MD, PhD
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi
Milan, Lombardia, Italy
Roberta Gualtierotti, MD, PhD

Associate Professor
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi
Milan, Lombardia, Italy
CM

Claudia Mistretta

MD
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi
Milan, Lombardia, Italy
GN

Gabriella Nicolò

Research Nurse
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Department of Healthcare Professions, Milan, Italy
Milano, Lombardia, Italy
SS

Simona Siboni

MD
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi
Milan, Lombardia, Italy
Flora Peyvandi, MD, PhD (she/her/hers)

Director
IRCCS Ca' Granda Maggiore Hospital Foundation, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milano, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milano, Italy
Milano, Lombardia, Italy

Background: Patients with hemophilia (PWH) have been thought to be protected from cardiovascular disease (CVD) because of their hypocoagulability. In view of the availability of new drugs that are improving the natural history of the bleeding disorder, their cardiovascular risk needs to be reconsidered. Data on cardiovascular risk factors in PWH remain poor.

Aims: To evaluate the association between common cardiovascular risk factors and carotid atherosclerosis in PWH.

Methods: We conducted a cross-sectional, case control study in a population of PWH A or B. Laboratory and clinical data regarding common cardiovascular risk factors were collected. Patients underwent both carotid ultrasound and echocardiography. Carotid atherosclerosis was defined by an IMT > 1 mm or the presence of carotid plaques. Odds ratio adjusted for age with their 95% confidence intervals (CI) were calculated.

Results: Fifty-eight PWH A or B (27 severe, 11 moderate and 20 mild) were included. Patients’ characteristics are reported in table 1. Ultrasound signs of atherosclerosis were found in 31 patients. Hypercholesterolemia (OR 3.1, 1.1-11.7 95% CI), hypertension (OR 2.3, 0.6-8.5 95% CI), and smoking (OR 4.1, 1.1-16.1 95% CI) resulted to be major risk factors for atherosclerosis, while we observed no association with obesity (0.9, 0.2-3.8 95% CI) and diabetes (1.3, 0.2-8.7 95% CI) (table 2). In addition, we found no association between the degree of hemophilia and atherosclerosis. Patients with hypertension showed a higher prevalence of septal hypertrophy and diastolic dysfunction (69% and 71%, respectively) compared with those without hypertension (44% and 50%, respectively).

Conclusion(s): Patients with any level of factor VIII do not seem protected from cardiovascular disease. Larger studies are warranted to understand the actual cardiovascular risk of PWH in the era of novel therapies.