Do Hemophilia A and von Willebrand Disease Protect Against Carotid Atherosclerosis? A Comparative Study Between . Coagulopathics and Normal Subjects by Means of Carotid Echo-Color Doppler Scan

Abstract

Atherosclerosis is a multifactorial disease caused by genetic and environmental factors with important clinical sequelae. The aim of this study was to evaluate the degree of carotid atherosclerosis by echo-color Doppler scan in a group of patients affected by hemophilia A and von Willebrand dis ease versus a group of normal subjects apparently free of ath erosclerotic risk factors. All coagulopathics and normal patients who came to our Internal Medicine Department (Padua Hospi tal) underwent physical exam, blood analysis, standard electro cardiogram, chest x-ray, echo-color Doppler scan, and a thor ough history. We examined 156 subjects, 76 coagulopathics (46 men, 30 women) and 77 normals (37 men, 40 women). Coagulopathics were affected by hypertension in 28.9% of cases, diabetes mellitus in 6.5%, dislipidemia in 17.1%, smoke in 39.4%, and obesity in 36.8% (p < .05). Echo-color Doppler scan revealed carotid plaques in 27.2% of control patients ver sus 13.1% of coagulopathics (p < .05). Hemophilics and sub jects with von Willebrand disease with a more serious illness had fewer plaques than those with lighter defects. Coagulopath ics showed 23.6% of the plaques we revealed on the whole, versus 76.3% of control subjects (p < .01), with a lighter degree of stenosis (p < .01). Our data demonstrate that patients with hemophilia A and von Willebrand disease have fewer carotid plaques and a smaller degree of carotid stenosis than normal subjects of the same sex and age. These data seem to strengthen the hypothesis that blood coagulation defects may allow pro tection against carotid atherosclerosis and its sequelae.