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(Circulation. 2001;104:762.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Decreased Coagulability Has No Clinically Relevant Effect on Atherogenesis

Observations in Individuals With a Hereditary Bleeding Tendency

A. rámek, MD; J.H.C. Reiber, PhD; W.B.J. Gerrits, MD; F.R. Rosendaal, MD

From the Departments of Clinical Epidemiology (A.S., F.R.R.), and Radiology (J.H.C.R.) and the Hemostasis and Thrombosis Research Center (F.R.R.), Leiden University Medical Center, Leiden; and the Department of Hematology (W.B.J.G.), Leyenburg Hospital, The Hague, the Netherlands.

Correspondence to Prof Dr F.R. Rosendaal, Department of Clinical Epidemiology, CO-P46, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands. E-mail f.r.rosendaal{at}lumc.nl

Background— Hemostasis affects ischemic cardiovascular disease through its role in formation of occluding arterial thrombi. Several studies suggest that hemostasis also might play a role in atherogenesis. We investigated whether individuals with an inherited bleeding tendency are protected against development of atherosclerosis.

Methods and Results— A total of 76 individuals with an inherited bleeding tendency (hemophilia and von Willebrand disease) and 142 healthy controls were included in the present study. Early atherosclerotic vessel-wall changes were quantified by measurement of intima-media thickness in the carotid and femoral arteries by B-mode ultrasonography. To validate intima-media thickness measurements, measurements also were performed in 77 individuals with clinically proven atherosclerosis and in 34 healthy, age-matched controls. A large difference in intima-media thickness was found between individuals with proven atherosclerosis and healthy controls, in particular for the femoral artery (difference for carotid artery, 0.16 mm; femoral artery, 0.53 mm). Comparison between patients with a bleeding tendency and healthy controls showed only minimally reduced intima-media in femoral artery in individuals with a bleeding tendency (adjusted difference, -0.078 mm; 95% CI, -0.17 to 0.018 mm). Subgroup analysis revealed that in subjects with moderate to severe hemophilia, vessel walls were thinnest (adjusted difference, -0.10 mm; 95% CI, -0.27 to 0.061 mm).

Conclusions— Hypocoagulability caused by hemophilia or von Willebrand disease has at most a limited effect on atherogenesis.

Key Words: atherosclerosis • coagulation • carotid arteries • femoral arteries • ultrasonics

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