BSH 2024 | Primary prevention against atherosclerosis in patients with hemophilia

With Caroline Dix, a research fellow who’s now a consultant in Melbourne, and Gerry Dolan, who’s our lead in hemophilia, we’ve looked at what we should be doing with our hemophilia patients these days because we are now treating them very well. In the 60s, their average length of life was still about 23, and now we’ve got superb treatments for them, they aren’t bleeding, they’ve got good joints, and their average life expectancy is up to about 73 years. And what is happening is that they’re actually getting atherosclerotic events, and that is what is killing them. And that’s quite surprising really. We looked back, and we know that having hemophilia doesn’t stop you from having atherosclerosis, but what having thin blood does do is stop you from having that final event where you make the clot that causes the heart attack or causes the stroke. So, we looked really at primary prevention in these groups of patients to see how we could reduce their risk of having heart attack and stroke. We’ve looked at the literature, there’s very little work there. We looked at exercise and clearly they would benefit from better exercise, but not if they’ve got joint disease, we need to find a way through there. They could improve diet. We need to be thinking about doing trials of statins in patients who’ve got hemophilia. And really, the hemophilia clinic is the place we’ve got to start thinking about it because these patients hardly ever go to the general practitioner. And so we are really asking hemophilia doctors to start thinking about primary prevention in their patients because hemophilia patients deserve the benefit of what everyone else is being told to do to reduce their risk of heart attack and stroke.