Heart Risk Higher in Less Active Adult Hemophilia Patients: Study

Higher blood pressure, abdominal fat reflect cardiovascular health risks

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Adults with moderate-to-severe hemophilia engage in less physical activity and have reduced physical fitness relative to healthy adults, according to a recent study.

Data also indicated these patients had more indicators of abdominal fat accumulation and more often had high blood pressure than healthy people, which could overall reflect a greater risk of cardiovascular health problems in this patient group.

“Personalised, multi-disciplinary health interventions, involving [physical activity], dietary and health psychology input from various medical and allied health disciplines, may reduce chronic health risk in the ageing haemophilia population,” the researchers wrote.

The study, “Physical activity, physical fitness and cardiometabolic risk amongst adults with moderate and severe haemophilia,” was published in Haemophilia

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As the life expectancy for hemophilia patients has increased, so has the risk of developing chronic conditions associated with aging, such as cardiovascular disease and type 2 diabetes.

For the general population, physical activity can offer protection against the development of these conditions, as well as reducing fall risks and improving psychological health. It stands to reason physical activity would be similarly beneficial among people with hemophilia.

But, due to bleeds and joint problems associated with hemophilia, patients may be less physically active than the general population, potentially putting them at higher risk for poor outcomes.

To learn more about the health status of adults with hemophilia, the researchers investigated physical activity levels, fitness, and cardiometabolic risk factors among 53 hemophilia patients at St. James’s Hospital in Dublin, Ireland. A control group of 33 healthy men without hemophilia was also included.

Among the hemophilia patients, 31 had severe hemophilia A, 15 severe hemophilia B, and seven people had moderate hemophilia of either type.

Physical activity was evaluated over a one-week period using a wearable movement tracker in combination with patient records.

Overall, patients and controls tended to participate in the same types of physical activity, but hemophilia patients were significantly less active than healthy controls, completing less moderate-to-vigorous physical activity.

A total of 72.9% of the hemophilia group met an activity guideline from the World Health Organization of 150 minutes of moderate weekly activity, compared with 90% of the healthy group.

Moreover, the number of people who achieved target activity levels via sustained bouts (at least 10 minutes) of moderate-to-vigorous activity was significantly lower in hemophilia patients (18.8%) compared with those without the bleeding disorder (56.7%).

“This may be related to the prevalent issues of chronic pain and functional disability associated with haemophilic arthropathy [joint disease],” among patients with hemophilia, the researchers wrote.

“The general [physical activity] guidelines may be beyond reach for some [people with moderate-to-severe hemophilia] who have significant comorbidities and the consequences of limited exercise tolerance may inhibit the magnitude of health benefits that can be achieved with [physical activity] alone.”

Consistently, reduced physical activity corresponded to reduced physical fitness in the hemophilia group, with these participants having lower performance across tests of aerobic capacity, muscle strength, and balance.

Abdominal fat, hypertension, joint health

While the prevalence of obesity and overall body fat or muscle mass were not significantly different between the two groups, hemophilia patients had a larger waist circumference, an indicator of more abdominal fat (abdominal adiposity).

More hemophilia patients were diagnosed with hypertension, or high blood pressure, although the difference from healthy controls wasn’t significant.

Among hemophilia patients, better joint health, as assessed by the hemophilia joint health score (HJHS), was correlated with measures of a healthier body composition, higher muscle strength, and a lower pulse wave velocity.

Pulse wave velocity is a measure of artery stiffness, reflecting the buildup of materials in the arteries that can eventually lead to a blockage and cardiovascular events.

Starting preventive hemophilia treatment at a younger age was likewise associated with measures of a healthier body composition, engagement in more vigorous exercise, better muscle strength, and a lower pulse wave velocity.

Artery stiffness and higher blood pressure also were associated with a history of Hepatitis C or HIV infection in hemophilia patients.

Older age was generally linked to higher arterial stiffness, body composition, lower physical activity, and worse physical fitness across both patients and healthy participants.

Overall, “low levels of [physical activity] and physical fitness, and significant rates of abdominal adiposity and hypertension may collectively influence the risk and severity of various cardiometabolic and/or musculoskeletal health issues,” in the aging hemophilia population, the researchers wrote.

“The mechanisms underlying the development of cardiometabolic risk factors in [moderate-to-severe hemophilia], such as hypertension and increased abdominal adiposity, also warrant further investigation.”