Decreased coagulability has no clinically relevant effect on atherogenesis- Observations in individuals with a hereditary bleeding tendency

Background-Hemostasis affects ischemic cardiovascular disease through its r ole in formation of occluding arterial thrombi. Several studies suggest tha t hemostasis also might play a role in atherogenesis. We investigated wheth er zn individuals with an inherited bleeding tendency are protected against development of atherosclerosis. Methods and Results-A total of 76 individuals with an inherited bleeding te ndency (hemophilia and von Willebrand disease) and 142 healthy controls wer e 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 thick ness 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 fem oral artery (difference for carotid artery, 0.16 m-m; femoral artery, 0.53 mm.). Comparison between patients with a bleeding tendency and healthy cont rols showed only minimally reduced intima-media in femoral artery in indivi duals with a bleeding tendency (adjusted difference, -0.078 nun; 95% Cl, -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 nun). Conclusions-Hypocoagulability caused by hemophilia or von Willebrand diseas e has at most a limited effect on atherogenesis.