title: Does deficiency of von Willebrand factor protect against cardiovascular disease? Analysis of a national discharge register.
abstract: BACKGROUND
  von Willebrand factor (VWF) plays a critical role in platelet adhesion and aggregation after vascular injury and at sites of high shear rate. Elevated VWF levels are associated with an increased risk of ischemic cardiovascular events; however, it is unclear whether VWF deficiency is protective against atherosclerosis. We aimed to compare the prevalence of cardiovascular disease (CVD) among patients with and without von Willebrand disease (VWD).
  
  
  METHODS
  A cross-sectional analysis was performed on discharge data for adults from the Nationwide Inpatient Sample (NIS) between the years 2009 and 2011. CVD was defined as ischemic heart disease, myocardial infarction, ischemic cerebrovascular disease, or peripheral vascular disease. For prevalence calculations and statistical analyses, we used discharge-level weights provided by the NIS to reflect national estimates. CVD was compared across groups by use of the Rao-Scott chi-square test. Multivariable logistic regression was used to estimate the likelihood of CVD in VWD patients after adjustment for age, gender, and CVD-related risk factors.
  
  
  RESULTS
  The prevalence of CVD in VWD patients was less than the prevalence of CVD in non-VWD patients (15.0% versus 26.0%). VWD was associated with a decreased likelihood of CVD after adjustment for age, gender, and CVD-related risk factors (odds ratio 0.85; 95% confidence interval 0.79-0.92).
  
  
  CONCLUSIONS
  These findings indicate that the risk of CVD is decreased among VWD patients, and that VWF deficiency may be protective against CVD.
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.|Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Seaman
authors.affiliation: Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Yabes
authors.affiliation: Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Comer
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.|Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Ragni
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000235:genetics; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D060467:Disease Resistance / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014842:von Willebrand Diseases / Q000097:blood / Q000453:epidemiology*; D014841:von Willebrand Factor / Q000032:analysis* / Q000502:physiology
chemical_list: D014841:von Willebrand Factor
keywords: cardiovascular disease; thrombosis; von Willebrand disease; von Willebrand factor; von Willebrand factor deficiency