Non-fatal cardiovascular disease, malignancies, and other co-morbidity in adult haemophilia patients.
BACKGROUND
With increasing life expectancy, more haemophilia patients will be confronted with age-related problems. To ensure optimal care, it is important to know the occurrence of both fatal and non-fatal cardiovascular disease, malignancies and other types of co-morbidity in these patients. Our aim was to retrospectively assess the occurrence of co-morbidity and causes of death in a substantial birth-cohort of haemophilia patients.


METHODS
Data on all types of co-morbidity were collected from medical records of 408 haemophilia patients (204 severe, 204 non-severe) born before 1971, and compared with the Dutch age-matched general male population.


RESULTS
Ten patients had 11 myocardial infarctions, none of which were fatal. The cumulative incidence of non-fatal myocardial infarction was significantly lower in patients with severe haemophilia than in the general population (0.5% versus 4.8%), but was not decreased in patients with non-severe haemophilia (4.4%). Intracranial bleeding occurred significantly more often in haemophilia patients. The occurrence of non-virus related malignancies, and other non-virus related co-morbidities was similar in haemophilia patients and the general population. HIV infection was present in 12% of patients, and hepatitis C infection in 56%. Seventy-eight patients (19%) were deceased. Main causes of death were malignancies, AIDS, hepatitis C, and intracranial bleeding.


CONCLUSIONS
Our results showed a decreased occurrence of myocardial infarction in patients with severe haemophilia, suggesting a protective effect of very low clotting factor levels on thrombotic cardiac events. No differences were found between haemophilia patients and the general population in the occurrence of any other type of non-virus related co-morbidity.
Van Creveldkliniek, Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands. D.E.FransenvandePutte@umcutrecht.nl
Dietje E
DE
Fransen  van de Putte
Kathelijn
K
Fischer
Astrid E
AE
Pulles
Goris
G
Roosendaal
Douwe H
DH
Biesma
Roger E G
RE
Schutgens
Eveline P
EP
Mauser-Bunschoten
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006467:Hemophilia A / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult