title: Factor VIII deficiency does not protect against atherosclerosis.
abstract: BACKGROUND
  Hemophilia A patients have a lower cardiovascular mortality rate than the general population. Whether this protection is caused by hypocoagulability or decreased atherogenesis is unclear.
  
  
  OBJECTIVE
  To evaluate atherosclerosis and endothelial function in hemophilia A patients with and without obesity as well as in matched, unaffected controls.
  
  
  METHODS
  Fifty-one obese (body mass index [BMI] ≥ 30 kg m(-2)) and 47 non-obese (BMI ≤ 25 kg m(-2)) hemophilia A patients, and 42 obese and 50 matched non-obese male controls were included. Carotid and femoral intima–media thickness [IMT] and brachial flow-mediated dilatation (FMD) were measured as markers of atherogenesis and endothelial function.
  
  
  RESULTS
  The overall population age was 50 ± 13 years. Carotid IMT was increased in obese subjects (0.77 ± 0.22 mm) as compared with non-obese subjects (0.69 ± 0.16 mm) [mean difference 0.07 mm (95% confidence interval [CI] 0.02–0.13, P = 0.008)]. No differences in mean carotid and femoral IMT between obese hemophilic patients and obese controls were found (mean difference of 0.02 mm [95% CI ) 0.07–0.11, P = 0.67], and mean difference of 0.06 mm [95% CI ) 0.13–0.25, P = 0.55], respectively). Thirty-five per cent of the obese hemophilic patients and 29% of the obese controls had an atherosclerotic plaque (P = 0.49), irrespective of the severity of hemophilia. Brachial FMD was comparable between obese hemophilic patients and obese controls (4.84% ± 3.24% and 5.32% ± 2.37%, P = 0.45).
  
  
  CONCLUSIONS
  Hemophilia A patients with obesity develop atherosclerosis to a similar extent as the general male population. Detection and treatment of cardiovascular risk factors in hemophilic patients is equally necessary.
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands. s.rafi@amc.uva.nl
authors.forename: Sara
authors.initials: S
authors.lastname: Biere-Rafi
authors.forename: A
authors.initials: A
authors.lastname: Tuinenburg
authors.forename: B W
authors.initials: BW
authors.lastname: Haak
authors.forename: M
authors.initials: M
authors.lastname: Peters
authors.forename: R
authors.initials: R
authors.lastname: Huijgen
authors.forename: E
authors.initials: E
authors.lastname: De Groot
authors.forename: P
authors.initials: P
authors.lastname: Verhamme
authors.forename: K
authors.initials: K
authors.lastname: Peerlinck
authors.forename: F L J
authors.initials: FL
authors.lastname: Visseren
authors.forename: M J H A
authors.initials: MJ
authors.lastname: Kruip
authors.forename: B A P
authors.initials: BA
authors.lastname: Laros-Van Gorkom
authors.forename: V E A
authors.initials: VE
authors.lastname: Gerdes
authors.forename: H R
authors.initials: HR
authors.lastname: Buller
authors.forename: R E G
authors.initials: RE
authors.lastname: Schutgens
authors.forename: P W
authors.initials: PW
authors.lastname: Kamphuisen
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000175:diagnosis / Q000209:etiology*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000503:physiopathology; D006467:Hemophilia A / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D012306:Risk; D015996:Survival Rate