Abstract 4148106: Hemophilia and Cardiovascular disease in the United States: Prevalence, Risk factors, and outcomes.

Background: Hemophilia is a rare X-linked recessive inherited bleeding disorder. Owing to improved management, the life expectancy of patients with hemophilia has increased significantly and predisposes them to risk of cardiovascular diseases and thrombotic events. However, studies on cardiovascular risk factors and outcomes in patients with hemophilia are limited. Aims: Therefore, the present study aimed to examine the prevalence of cardiovascular disease, the risk factors, and the outcomes in patients with hemophilia. Methods: The study identified all adult males with a primary and secondary diagnosis of hemophilia in the National Inpatient Sample (NIS) database from 2018 – 2020. The overall study population was compared to the general population, non-hemophilia. The primary outcome was to estimate the prevalence of cardiovascular risk factors in patients with hemophilia compared to the general population. The secondary outcomes comprise the odds of adverse events, including myocardial infarction, ischemic stroke, transient ischemic attack (TIA), occlusive atherosclerotic disease, percutaneous coronary intervention, and coronary artery bypass graft (CABG)., We conducted a multivariate logistic regression to estimate the odds of the outcomes Results: Out of the total 7,377,811 adult male study population, 11,291 (0.2%) had hemophilia, and 7,377,811 (99.8%) with non-hemophilia. The hemophilia cohort was slightly older (63.2[16.8] vs. 61.5[17.4]) and was also more likely to have diabetes mellitus, hyperlipidemia, chronic lung disease, chronic kidney disease, chronic liver disease, BMI ≥ 25, anemia, metastatic cancer, and atrial fibrillation. In the adjusted models, patients with hemophilia had higher odds of myocardial infarction (OR 2.62, 95% CI: 2.47 – 2.77), ischemic stroke (OR 2.71, 95% CI: 2.53 – 2.89), TIA (OR 10.44, 95% CI: 9.40 – 11.60), occlusive atherosclerotic disease (OR 2.31, 95% CI: 2.08 – 2.56), PCI (OR 5.31, 95% CI: 4.86 – 5.80), and CABG (OR 7.62, 95% CI: 6.97 – 8.33). Conclusions: Our study found that patients with hemophilia had a higher prevalence of cardiovascular risk factors and adverse events compared to males without hemophilia in the United States. Further research is to identify potential ex-specific risk factors that predispose to worse cardiovascular outcomes among patients with hemophilia.