Abstract
The clinical focus of haemophilia has expanded beyond bleeding outcomes to encompass long-term comorbidities such as cardiovascular disease (CVD). However, it remains unclear when vascular changes begin in this population. Carotid intima-media thickness (cIMT), a validated, non-invasive marker of subclinical atherosclerosis, may help detect early vascular remodelling in youth with haemophilia, even in the absence of conventional CVD risk factors.
This single-centre, cross-sectional study compared adolescent males (ages 10-21 years) with severe haemophilia (FVIII or IX <1%) to age-matched healthy controls. Bilateral carotid ultrasonography was performed, and right-sided cIMT was the prespecified primary endpoint. Conventional CVD clinical risk factors were also collected.
Thirty-eight participants were enrolled, 22 with haemophilia and 16 controls. Median right cIMT was higher in the haemophilia group (0.40 mm, SD 0.08 range 0.35-0.47) versus the control group (0.38 mm, SD 0.06 range 0.32-0.39; p = 0.009). When referenced to age-and-height specific nomograms, cIMT percentiles were also elevated in the haemophilia group (6.5% vs. 1.6%; p = 0.026 and 12.9% vs. 1.7%; p = 0.018; respectively). HDL-cholesterol was significantly lower in the haemophilia group (48.9 SD 9.9 vs. 60.2 SD 14.9 mg/dL; p = 0.012). No correlations were found between cIMT and any CVD risk factors.
Adolescent males with severe haemophilia show early arterial thickening, suggesting that vascular remodelling in this population may begin in adolescence. Incorporating cIMT and CVD risk assessment into routine haemophilia care may support timely interventions and reduce long-term cardiovascular complications.