PO078 | CARDIOVASCULAR EVENTS AND SUBCLINICAL ATHEROSCLEROSIS IN HEMOPHILIA A AND B PATIENTS: A MULTICENTER COHORT STUDY

A. Napolitano, E. Zanon, L. Spiezia, G. Camporese, P. Scarinzi, F. Ahmad, G. Saggiorato, C. Bulato, S. Toffanin, S. Gavasso, P. Zerbinati, C. Simion, E. Campello, P. Simioni | Department of Medicine, University of Padova, Italy

Background and Aims. Advances in hemophilia care have significantly improved life expectancy, thereby increasing exposure to cardiovascular risk. Although hemophilia has traditionally been considered protective against thrombosis, cardiovascular events are increasingly recognized in this population. This study aims to evaluate the prevalence and predictors of cardiovascular events in patients with hemophilia A and B, and to investigate their association with both clinical and subclinical atherosclerosis.
Methods. We conducted a multicenter ambispective observational cohort study including 163 patients aged >40 years with hemophilia A or B (139 hemophilia A; 24 hemophilia B), followed at the Hemophilia Centers of Padua and Castelfranco Veneto, in North-East Italy. Patients were divided into two groups according to the occurrence of clinical events (myocardial infarction, stroke/TIA, and venous thrombosis). Demographic, clinical, laboratory, and treatment-related variables were collected. ROTEM and Multiplate assays were performed. All participants underwent carotid ultrasound, abdominal aorta diameter measurement, and ankle-brachial index (ABI) assessment. Associations with outcomes were evaluated using univariate analyses and multivariable logistic regression models.
Results. A total of 16.6% of patients (27/163) experienced at least one event, which occurred more frequently in patients with mild compared to severe hemophilia (70.4% vs 40.4%; p = 0.0199), with no significant difference between hemophilia A and B (p = 0.545). Patients with events were significantly older than those without (67.8 ± 12.2 vs 55.7 ± 10.7 years; p = 0.001). Patients with events showed a higher prevalence of cardiovascular and metabolic comorbidities, including hypertension (66.6% vs 38.2%; p = 0.01), dyslipidemia (59.3% vs 38.2%; p = 0.04), and cancer (37% vs 13.2%; p = 0.004). In multivariable analysis, events were independently associated with HIV infection (OR 6.51; 95% CI 1.38–30.77), hypertension (OR 3.17; 95% CI 1.31–7.68), and dyslipidemia (OR 2.38; 95% CI 1.02–5.56). Imaging and vascular assessments showed greater carotid plaque thickness, larger abdominal aorta diameter, and a higher prevalence of abnormal ABI (<1) in patients with events (p = 0.006, p = 0.03, and p = 0.001, respectively).Laboratory analyses revealed significantly lower hemoglobin (p = 0.0076) and platelet counts (p = 0.0037) in patients with events. Renal function was also impaired, as indicated by higher creatinine levels (p = 0.0182). In addition, NT-proBNP (p = 0.02) and troponin I (p = 0.004) were significantly increased in patients with events. Thromboelastometry demonstrated a shorter INTEM clotting time in patients with events (p = 0.0037), while platelet function testing showed significantly reduced ASPI AUC (p = 0.03) and TRAP AUC (p = 0.002).Kaplan–Meier analysis showed no significant difference in event-free survival between patients with mild and severe hemophilia (p = 0.94) (Figure 1).
Conclusions. Thrombotic and cardiovascular events occurred in a minority of patients with hemophilia A and B and were more frequent among older individuals, patients with mild disease, and those with HIV infection. Events were associated with traditional cardiovascular risk factors and markers of subclinical atherosclerosis, emphasizing the importance of comprehensive cardiovascular evaluation in this population.