Atherosclerosis in Patients with Congenital Hemophilia: A Focus on Peripheral Artery Disease

Area of Science:

• Cardiovascular Medicine
• Hematology

Background:

• Hemophilia treatment advances increase life expectancy, leading to age-related comorbidities like cardiovascular disease.
• Coronary atherosclerosis and myocardial infarction are known hemophilia comorbidities, but peripheral artery disease (PAD) is less understood.
• Hemophiliacs share cardiovascular risk factors and atherosclerosis burdens with the general population.

Purpose of the Study:

• To investigate the prevalence and implications of peripheral artery disease in hemophilia patients.
• To understand the interplay between impaired coagulation and traditional cardiovascular risk factors in hemophilia-related atherosclerosis.
• To assess the safety and necessity of screening for cardiovascular risk factors and PAD in hemophilia care.

Main Methods:

• Review of available data on cardiovascular risk factors and atherosclerosis in hemophiliacs.
• Analysis of factors contributing to cardiovascular mortality in this population.
• Evaluation of evidence regarding invasive treatments and antithrombotic therapy in hemophilia.

Main Results:

• Hemophiliacs exhibit cardiovascular risk factors and atherosclerosis comparable to the general population.
• Lower cardiovascular mortality in hemophiliacs is attributed to impaired thrombus formation and plaque phenotype, not atherosclerosis burden.
• Traditional cardiovascular risk factors significantly influence the onset and progression of atherosclerotic lesions.

Conclusions:

• Screening for traditional cardiovascular risk factors and peripheral artery disease should be integrated into standard hemophilia care.
• Despite impaired clotting, traditional risk factors are primary drivers of atherosclerosis in hemophilia.
• Invasive treatments and antithrombotic therapies are generally safe in hemophilia patients with appropriate coagulation factor management.