title: Cardiovascular disease (CVD) in Canadians with haemophilia: Age-Related CVD in Haemophilia Epidemiological Research (ARCHER study).
abstract: BACKGROUND
  Improvements in haemophilia care have increased life expectancy in persons with haemophilia (PWH). This ageing population presents clinicians with management challenges as they develop age-related comorbidities such as cardiovascular disease (CVD).
  
  
  OBJECTIVE
  To assess the epidemiology of CVD risk factors and events in an ageing Canadian haemophilia population.
  
  
  METHODS
  A retrospective, multicentre chart review was carried out at five Canadian Hemophilia Treatment Centres. PWH (A and B) ≥35 years old were included and data were extracted on CVD risk factors and events.
  
  
  RESULTS
  Data from 294 patients' charts were analysed including 222 (75.5%) patients with haemophilia A and 72 (24.5%) patients with haemophilia B with a median age at end of follow-up of 54 years (range = 36-90). Mean follow-up duration was 5.86 years. Cardiovascular risk factors were common: hypertension 31.3% (n = 90), diabetes mellitus 10.5% (n = 29), smoking 21.8% (n = 61), obesity 27.6% (n = 69), dyslipidaemia 22.4% (n = 65), family history 8.5% (n = 24), antiretroviral therapy 12.2% (n = 36). There were 24 CVD events (8.2% of the population) with a median age at event of 63 years (range = 46-83). Events consisted of coronary artery disease (CAD), 14; cerebrovascular disease, 4; and atrial fibrillation, 7. CAD was treated with coronary artery bypass grafting in three patients and percutaneous coronary intervention in nine patients. CVD events were complicated by six bleeding events (three minor and three major).
  
  
  CONCLUSIONS
  Cardiovascular disease risk factors and events are relatively common in PWH. PWH can be safely treated for CVD events with similar procedures as the non-PWH populations, though specific clotting factor prophylaxis protocols are not well defined.
authors.affiliation: Division of Hematology, Department of Medicine, Western University, London, ON, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Minuk
authors.affiliation: Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Jackson
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-3331-8766
authors.initials: A
authors.lastname: Iorio
authors.affiliation: Department of Medicine and The Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
authors.forename: M-C
authors.initials: MC
authors.lastname: Poon
authors.affiliation: Division of Hematology, Department of Medicine, Western University, London, ON, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Dilworth
authors.affiliation: Division of Hematology, University of Saskatchewan, Saskatoon, AB, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Brose
authors.affiliation: Division of Hematology, University of Saskatchewan, Saskatoon, AB, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Card
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Rizwan
authors.affiliation: Division of Hematology, Department of Medicine, Western University, London, ON, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Chin-Yee
authors.affiliation: Division of Hematology, Department of Medicine, Western University, London, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Louzada
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: ageing; cardiovascular disease; cardiovascular risk factors; haemophilia; life expectancy