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Cardiovascular disease risk factors: prevalence and management in adult hemophilia patients

Lim, Ming Y.a; Pruthi, Rajiv K.b

Blood Coagulation & Fibrinolysis: July 2011 - Volume 22 - Issue 5 - p 402–406
doi: 10.1097/MBC.0b013e328345f582
Original Articles

With increasing longevity, the prevalence of cardiovascular disease (CVD) risk factors in hemophilia patients is expected to increase; however, evidence-based guidelines on management are lacking. The aim of the study was to determine the prevalence and management of CVD risk factors in hemophilia patients. A retrospective study of 58 adult hemophilia patients (≥35 years) attending Mayo Comprehensive Hemophilia Center between 1 January 2006 and 15 October 2009 were reviewed. The prevalence of CVD risk factors was hypertension 65.5%, diabetes 10.3%, smoking 12.5% and obesity 19.6%. A total of 31% did not have a lipid profile on record. Management of risk factors included antihypertensive medications in 84.2% and lipid-lowering agents in 12.1%. During their medical evaluation, four of seven active smokers received smoking cessation counseling and four of 11 obese patients received lifestyle modification advice. Eight patients (13.8%) experienced a CVD event: myocardial infarction (MI) (n = 3), coronary artery disease (n = 2), both MI and ischemic stroke (n = 1) and hemorrhagic strokes (n = 2). Only five of eight patients were on low-dose aspirin, of which aspirin was discontinued in one patient after he was diagnosed with hemophilia following a bleeding work-up. Another patient on dual antiplatelet therapy post stent placement developed epistaxis resulting in clopidogrel cessation. Hemophilia patients are at risk for CVD, similar to the general age-matched male population. Screening for CVD risk factors, with preventive dietary and pharmacologic interventions, play a key role in the prevention and long-term management of CVD. Collaborative efforts between primary care providers, cardiologists and hemophilia center specialists remain essential in managing these complex patients.

aDepartment of Internal Medicine

bMayo Comprehensive Hemophilia Center, Mayo Clinic, Rochester, Minnesota, USA

Correspondence to Rajiv K. Pruthi, MBBS, Hilton 200 SCL, 200 First Street SW, Rochester, MN 55905, USATel: +1 507 284 2677; fax: +1 507 284 8286; e-mail: pruthi.rajiv@mayo.edu

Received 3 February, 2011

Revised 17 February, 2011

Accepted 19 February, 2011

© 2011 Lippincott Williams & Wilkins, Inc.