Coronary Artery Calcification in Hemophilia A: No Evidence for a Protective Effect of Factor VIII Deficiency on Atherosclerosis

• Published in: Arteriosclerosis, thrombosis, and vascular biology Vol. 32; no. 3; pp. 799 - 804
• Main Authors: Tuinenburg, Attie, Rutten, Annemarieke, Kavousi, Maryam, Leebeek, Frank W.G., Ypma, Paula F., Laros-van Gorkom, Britta A.P., Nijziel, Marten R., Kamphuisen, Pieter W., Mauser-Bunschoten, Eveline P., Roosendaal, Goris, Biesma, Douwe H., van der Lugt, Aad, Hofman, Albert, Witteman, Jacqueline C.M., Bots, Michiel L., Schutgens, Roger E.G.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.03.2012; Lippincott Williams & Wilkins
• Subjects: Age Factors; Aged; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Blood Coagulation - genetics; Cardiology. Vascular system; Case-Control Studies; Chi-Square Distribution; Coronary Angiography - methods; Coronary Artery Disease - blood; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary heart disease; Cross-Sectional Studies; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Heart; Hemophilia A - blood; Hemophilia A - epidemiology; Hemophilia A - genetics; Humans; Linear Models; Male; Medical sciences; Middle Aged; Netherlands - epidemiology; Predictive Value of Tests; Prospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Tomography, X-Ray Computed; Vascular Calcification - blood; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology; hemophilia; Deficiency; Coronary artery; Factor VIII; Cardiovascular disease; Hemopathy; Coronary heart disease; coagulation; imaging; Hemophilia A; Genetic disease; Vascular disease; Prevention; Atherosclerosis; Calcification; Coagulopathy
• ISSN: 1079-5642; 1524-4636; 1524-4636
• DOI: 10.1161/ATVBAHA.111.238162

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, ≥59 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 (β) of the natural log–transformed Agatston score between men with and without hemophilia was 0.141 (95% CI −0.602 to 0.885, P=0.709). Results did not change after adjustment for age, body mass index, hypercholesterolemia, hypertension, and use of antidiabetic medication (β=0.525, 95% CI −0.202 to 1.252, P=0.157). Comparable results were found for calcification mass. CONCLUSION—The extent of coronary artery atherosclerosis is comparable between elderly men with and without hemophilia. Results from this study underline the importance of screening and treating atherosclerosis risk factors in hemophilia patients.