title: Decreased coagulability has no clinically relevant effect on atherogenesis: observations in individuals with a hereditary bleeding tendency.
abstract: BACKGROUND
  Hemostasis affects ischemic cardiovascular disease through its role in formation of occluding arterial thrombi. Several studies suggest that hemostasis also might play a role in atherogenesis. We investigated whether individuals with an inherited bleeding tendency are protected against development of atherosclerosis.
  
  
  RESULTS
  A total of 76 individuals with an inherited bleeding tendency (hemophilia and von Willebrand disease) and 142 healthy controls were included in the present study. Early atherosclerotic vessel-wall changes were quantified by measurement of intima-media thickness in the carotid and femoral arteries by B-mode ultrasonography. To validate intima-media thickness measurements, measurements also were performed in 77 individuals with clinically proven atherosclerosis and in 34 healthy, age-matched controls. A large difference in intima-media thickness was found between individuals with proven atherosclerosis and healthy controls, in particular for the femoral artery (difference for carotid artery, 0.16 mm; femoral artery, 0.53 mm). Comparison between patients with a bleeding tendency and healthy controls showed only minimally reduced intima-media in femoral artery in individuals with a bleeding tendency (adjusted difference, -0.078 mm; 95% CI, -0.17 to 0.018 mm). Subgroup analysis revealed that in subjects with moderate to severe hemophilia, vessel walls were thinnest (adjusted difference, -0.10 mm; 95% CI, -0.27 to 0.061 mm).
  
  
  CONCLUSIONS
  Hypocoagulability caused by hemophilia or von Willebrand disease has at most a limited effect on atherogenesis.
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden.
authors.forename: A
authors.initials: A
authors.lastname: Srámek
authors.forename: J H
authors.initials: JH
authors.lastname: Reiber
authors.forename: W B
authors.initials: WB
authors.lastname: Gerrits
authors.forename: F R
authors.initials: FR
authors.lastname: Rosendaal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D001777:Blood Coagulation; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D020147:Coagulation Protein Disorders / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D018450:Disease Progression; D004562:Electrocardiography; D005263:Femoral Artery / Q000000981:diagnostic imaging; D020022:Genetic Predisposition to Disease; D006467:Hemophilia A / Q000097:blood / Q000150:complications / Q000175:diagnosis; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014842:von Willebrand Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis