Do hemophilia A and von Willebrand disease protect against carotid atherosclerosis? A comparative study between coagulopathics and normal subjects bymeans of carotid echo-color Doppler scan

Atherosclerosis is a multifactorial disease caused by genetic and environme ntal 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 disease versus a group of normal subjects apparently free of atherosclerotic risk f actors. All coagulopathics and normal patients who came to our internal Med icine Department (Padua Hospital) underwent physical exam, blood analysis, standard electrocardiogram, chest x-ray, echo-color Doppler scan, and a tho rough history. We examined 156 subjects, 76 coagulopathics (46 men, 30 wome n) and 77 normals (37 men, 40 women). Coagulopathics were affected by hyper tension 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 r evealed carotid plaques in 27.2% of control patients versus 13.1% of coagul opathics (p < .05). Hemophilics and subjects with von Willebrand disease wi th a more serious illness had fewer plaques than those with lighter defects . Coagulopathics showed 23.6% of the plaques we revealed on the whole, vers us 76.3% df control subjects (p < .01), with a lighter degree of stenosis ( p < .01). Our data demonstrate that patients with hemophilia A and von Will ebrand disease have fewer carotid plaques and a smaller degree of carotid s tenosis than normal subjects of the same sex and age. These data seem to st rengthen the hypothesis that blood coagulation defects may allow protection against carotid atherosclerosis and its sequelae.