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Badescu MC, Badulescu OV, Costache AD, Mitu O, Lupu VV, Dmour BA, Lupu A, Foia LG, Costache II, Rezus C. Atherosclerosis in Patients with Congenital Hemophilia: A Focus on Peripheral Artery Disease. Life (Basel) 2023; 13:2221. [PMID: 38004361 PMCID: PMC10672485 DOI: 10.3390/life13112221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Advances in the treatment of hemophilia have increased the life expectancy of this population and we are currently facing diseases associated with aging, including cardiovascular ones. Coronary atherosclerosis, with acute myocardial infarction as the most severe form of manifestation, has been recognized as part of the comorbidities of hemophiliacs. However, little is known about peripheral artery disease. Available data show that hemophiliacs have cardiovascular risk factors and atherosclerosis similar to the general population. Impaired thrombus formation and phenotype of atheroma plaque rather than the burden of atherosclerosis explains their lower cardiovascular mortality. Since the effect of traditional cardiovascular risk factors overpowers that of decreased coagulability and promotes the onset and progression of atherosclerotic lesions, screening for traditional cardiovascular risk factors and peripheral artery disease should be integrated into standard hemophilia care. There is evidence that invasive treatments and long-term antithrombotic therapy are generally safe, provided that coagulation factor levels are taken into account and replacement therapy is given when necessary.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania (A.L.)
| | - Bianca-Ana Dmour
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
| | - Ancuta Lupu
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania (A.L.)
| | - Liliana Georgeta Foia
- Department of Biochemistry, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Irina-Iuliana Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Cardiovascular Risk Factors in Patients with Congenital Hemophilia: A Focus on Hypertension. Diagnostics (Basel) 2022; 12:diagnostics12122937. [PMID: 36552943 PMCID: PMC9776547 DOI: 10.3390/diagnostics12122937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022] Open
Abstract
Aging hemophiliacs face cardiovascular disease. Lots of evidence has been gathered that hemophiliacs have a more unfavorable cardiovascular profile than the general population does, especially due to the increased prevalence of hypertension (HTN). Among the existing scattered evidence, our study provides the most comprehensive and systematized analysis of the determinants of HTN in hemophiliacs. We discussed the contribution to the HTN substrate of hemophilia-specific factors, such as type, severity and the presence of inhibitors. The complex mechanism of kidney dysfunction in relation to hematuria and viral infections was meticulously addressed. Furthermore, we highlighted the new pathogenic concepts of endothelial dysfunction and the association between HTN and hemophilic arthropathy. The clustering of cardiovascular risk factors is common in hemophiliacs, and it enhances the negative vascular effect of HTN and aggravates HTN. It usually leads to an increased risk for coronary and cerebrovascular events. Our work provides reliable evidence to guide and improve the management of HTN in hemophiliacs.
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Zhang F, Zong X, Zhou X, Sun S, Xiao X, Sun J. Naive haemophilia mice displayed different pattern of cytokine profiles of cytokine profiles changes might be associated with subclinical bleeding. Blood Coagul Fibrinolysis 2021; 32:584-590. [PMID: 34693916 DOI: 10.1097/mbc.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Subclinical bleeding is a haemorrhage event not clinically detected in haemophilia, and no reliable method is available for predicting subclinical bleeding. We investigated whether haemophilia mice have subclinical haemorrhage and evaluated potential biomarkers including multiple cytokine changes to predict subclinical haemorrhage. Plasma from naïve FVIII-/- and FIX-/- mice and their wild-type counterparts (FVIII WT and FIX WT, respectively) were measured for prothrombin fragment 1 + 2 (F1 + 2) and multiple cytokines. Haemophilia mice with induced hemarthrosis were used as positive clinical bleeding controls. Naive haemophilia mice that displayed higher levels than positive bleeding control were counted. Univariate and multivariate analyses of cytokines were performed. Compared with wild-type mice (FVIII WT 1.1-6.2 vs. FIX WT 2.7-6.7 pmol/l), F1 + 2 widely varied in both haemophilia mouse strains (FVIII-/- 3.7-25.7 vs. FIX-/- 2.7-15.7 pmol/l). Each cytokine varied widely in both naive haemophilia A and B mice, but not significantly, for most cytokines. In comparison to haemophilia mice with hemarthrosis bleeding challenge, naive FVIII-/- mice had elevated pro-inflammatory cytokines and FIX-/- mice had elevated anti-inflammatory cytokines. In addition, interleukin (IL)-4, followed by IL-1, IL-6, TNF-α and MIP-1α in FVIII-/- mice and MIP-1α, followed by IL-1, IL-10 in FVIII-/- mice exhibited significant differences potentially associated with potential subclinical bleeding. Naive haemophilia mice showed elevated pro-inflammatory cytokines with different patterns, represented by pro-inflammatory cytokine elevation in more naïve FVIII-/- mice and more anti-inflammatory cytokines in FIX-/- mice.
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Affiliation(s)
| | - Xiaoying Zong
- School of Pharmacy, East China University of Science and Technology, Shanghai, China
| | - Xinyue Zhou
- School of Pharmacy, East China University of Science and Technology, Shanghai, China
| | | | - Xiao Xiao
- School of Biotechnology
- School of Pharmacy, East China University of Science and Technology, Shanghai, China
- The State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, China
| | - Junjiang Sun
- Gene Therapy Center
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
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Camelo RM, Caram-Deelder C, Duarte BP, de Moura MCB, Costa NCDM, Costa IM, Roncal CGP, Vanderlei AM, Guimaraes TMR, Gouw S, Rezende SM, van der Bom J. Cardiovascular risk factors among adult patients with haemophilia. Int J Hematol 2021; 113:884-892. [PMID: 33677769 DOI: 10.1007/s12185-021-03104-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
Since the introduction of episodic and prophylactic treatments with safer factor concentrates, the life expectancy of people with haemophilia (PwH) has improved considerably. Ageing-related diseases such as cardiovascular disease (CVD) have also become more prevalent in PwH. This cross-sectional study aimed to evaluate CVD risk factors and estimate 10-year risk for CVD events among PwH. Male patients ≥ 30 years were interviewed and examined. Blood tests were performed at the local laboratory. Eighty-two patients were included, of whom 83% had haemophilia A and half had severe disease. Median age at study entry was 43.0 years (interquartile range [IQR], 36.0-51.3). Prevalence of obesity, systemic arterial hypertension (SAH) and diabetes mellitus were 16%, 60% and 16%, respectively. Hypertriglyceridaemia, hypercholesterolaemia and low HDL blood levels were present in 18%, 41% and 30% of patients, respectively. Metabolic syndrome was found in 37%. The Framingham Risk Score showed that 39% of PwH had a high risk of developing cardiovascular events in the following 10 years. We conclude that, in this cohort, PwH have a higher prevalence of SAH when compared with Brazilian men without haemophilia and about two-fifths have a high risk of developing a CVD event in the following 10 years.
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Affiliation(s)
- Ricardo Mesquita Camelo
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 2nd Floor, Room 255, Belo Horizonte, MG, 30130-100, Brazil. .,Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil. .,Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Camila Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Jon J Van Rood Centre for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
| | - Bruna Pontes Duarte
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | | | | | - Iris Maciel Costa
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | | | - Ana Maria Vanderlei
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | - Tania Maria Rocha Guimaraes
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil.,Faculdade de Enfermagem Nossa Senhora das Gracas, Universidade de Pernambuco, Recife, Brazil
| | - Samantha Gouw
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Paediatric Haematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Suely Meireles Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 2nd Floor, Room 255, Belo Horizonte, MG, 30130-100, Brazil
| | - Johanna van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Jon J Van Rood Centre for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
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Özdemir ZC, Köşger P, Uçar B, Bör Ö. Myocardial functions, blood pressure changes, and arterial stiffness in children with severe hemophilia A. Thromb Res 2020; 189:102-107. [PMID: 32197138 DOI: 10.1016/j.thromres.2020.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/17/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Prolonging the life span of patients with hemophilia has led to the emergence of comorbidities. Cardiovascular diseases are one of the important causes of mortality in patients with hemophilia. This study investigated the myocardial functions, blood pressure changes, arterial stiffness, and risk factors associated with cardiovascular diseases in children with hemophilia. MATERIAL AND METHODS In total, 17 children with severe hemophilia A and 23 healthy children were included in the study. Myocardial functions were evaluated using standard and tissue Doppler echocardiography. Peripheral and central blood pressure measurements were performed, and arterial stiffness was evaluated. Carotid intima-media thicknesses (CIMT) serum glucose, insulin, insulin resistance index, and lipoprotein levels were measured. RESULTS There were no differences between the two groups in terms of age, and biochemical parameters (P > 0.05). The HDL-C levels in the hemophilia group were lower than those in the control group (P < 0.05). Five of the patients had insulin resistance (29.4%), whereas four had low HDL-C levels (23.5%). There were no differences between the groups in terms of the CIMT, peripheral blood pressure, and central systolic blood pressure (P > 0.05). In the hemophilia group, central diastolic blood pressure (cDBP), arterial stiffness, and myocardial performance index were higher (P < 0.05, P = 0.01, P < 0.01), whereas the ejection time was shorter than in the control group (P < 0.05). CONCLUSIONS Compared with the control group, there is an onset of arterial stiffness, cDBP values tend to increase, and serum HDL-C levels are lower in the hemophilia group. Moreover, myocardial systolic functions demonstrate a deterioration that becomes more prominent with the increase in arterial stiffness.
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Affiliation(s)
- Zeynep Canan Özdemir
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey.
| | - Pelin Köşger
- Division of Pediatric Cardiology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey
| | - Birsen Uçar
- Division of Pediatric Cardiology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey.
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Yıldız M, Özdemir N, Önal H, Koç B, Eliuz Tipici B, Zülfikar B. Evaluation of Unfavorable Cardiovascular and Metabolic Risk Factors in Children and Young Adults with Haemophilia. J Clin Res Pediatr Endocrinol 2019; 11:173-180. [PMID: 30582317 PMCID: PMC6571541 DOI: 10.4274/jcrpe.galenos.2018.2018.0292] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Increased risk of unfavorable cardiovascular risk factors has been recognised in ageing patients with haemophilia (PwH), but needs further studies in younger patients. The purpose of this study was to assess obesity, hypertension (HT), metabolic variables, insulin resistance and metabolic syndrome in young PwH. METHODS Forty-eight haemophilia A and B patients and 35 age and sex matched healthy controls were included in the study. Anthropometric measurements, blood pressure (BP), fasting glucose and insulin levels, serum lipids and diet were evaluated. The metabolic syndrome was defined according to the criteria of the International Diabetes Federation for pediatric and adult age groups. RESULTS The mean age of PwH was 21±9 years (range, 6-40 years). Of those ≥18 years, 46% were were obese/overweight while there were no obese/overweight cases in the <18 year-old patients. Obesity was more prevalent in PwH with arthropathy (p=0.017). Seven percent of the PwH between 10 and 18 years-old and 25% of those ≥18 years had metabolic syndrome. There was no difference in metabolic syndrome frequency between PwH and controls >10 years-old (19.5% vs 10% respectively, p=0.34). Fifty percent of the PwH ≥18 years-old had elevated BP or HT. Fasting blood glucose levels of PwH were significantly higher compared to controls (p=0.02). CONCLUSION Our study showed that obesity, HT and metabolic syndrome are frequent problems, especially in PwH with arthropathy. Early prevention and management of overweight, obesity and their sequelae must be addressed in clinical practice in order to maximize the overall health of the haemophilia population.
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Affiliation(s)
- Melek Yıldız
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey,* Address for Correspondence: İstanbul University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 505 746 51 76 E-mail:
| | - Nihal Özdemir
- İstanbul University Cerrahpaşa Faculty of Medicine and Oncology Institute, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Hasan Önal
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, İstanbul, Turkey
| | - Başak Koç
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey
| | - Beyza Eliuz Tipici
- İstanbul University İstanbul Faculty of Medicine, Department of Nutrition and Dietetics, İstanbul, Turkey
| | - Bülent Zülfikar
- İstanbul University Cerrahpaşa Faculty of Medicine and Oncology Institute, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
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Yang M, Sun HL, Jackson SC. Erectile dysfunction in patients with haemophilia. Haemophilia 2019; 25:283-288. [PMID: 30817087 DOI: 10.1111/hae.13707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/15/2018] [Accepted: 01/27/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Patients with haemophilia (PWH) are experiencing a nearly normal life span with safe factor replacement therapy and effective antiviral treatments for co-infections. As a result, many ageing-related health issues are starting to emerge. One rarely discussed health issue is erectile dysfunction (ED). ED can affect overall well-being and predict future cardiac events, but is not well studied in PWH. AIM This prospective study aims to examine the prevalence and risk factors for ED in PWH using the validated International Index of Erectile Function (IIEF) questionnaire. METHODS Patients with haemophilia A and B at all severities were invited to participate in IIEF questionnaire at the provincial Hemophilia Treatment Centre. Risk factors for ED including cardiovascular risk factors, prior surgeries, viral infections, medications and haemophilia-specific factors were obtained. Fasting laboratory tests including but not limited to renal function, haemoglobin, lipid profile, glucose and CRP were performed the same day. Blood pressure and anthropomorphic indices were measured. Endothelial function was assessed by brachial artery flow-mediated dilation (FMD and hyperaemic velocity time integral [VTI]). RESULTS Out of the 56 subjects approached, 44 completed the IIEF. Median age was 49 years. About 38.6% of the cohort reported ED symptoms. There was no significant difference in endothelial function measured by FMD and VTI between patient with ED and without. IIEF score correlated with age in multivariable analysis. CONCLUSION Erectile dysfunction symptoms appear prevalent in PWH, particularly in the older group. This disorder along with the underlying causes needs to be explored further in future larger observational study.
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Affiliation(s)
- Ming Yang
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Haowei Linda Sun
- Division of Hematology, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon C Jackson
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia (UBC) and St. Paul's Hospital, Vancouver, British Columbia, Canada
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Limjoco J, Thornburg CD. Risk factors for cardiovascular disease in children and young adults with haemophilia. Haemophilia 2018; 24:747-754. [PMID: 30004151 PMCID: PMC6153073 DOI: 10.1111/hae.13585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The origins of cardiovascular disease (CVD) begin in childhood. The primary objective of this cross-sectional cohort study was to determine the prevalence of cardiovascular risk factors in patients with congenital haemophilia A or B followed at Rady Children's Hospital San Diego Hemophilia and Thrombosis Treatment Center (HTC). We hypothesized that cardiovascular risk factors could be identified as part of a comprehensive clinic visit. MATERIALS AND METHODS Standardized measurement of weight, height, waist circumference and blood pressure plus non-fasting glucose and lipid panel were performed. Participants and/or caregivers completed questionnaires about family history, medical history and lifestyle. Clinical data were abstracted from the medical record. Descriptive statistics, Student's t test, correlation, Mann-Whitney U test and chi-square test were performed to analyse the data. RESULTS Forty-three males (mean 12 years, range 5-20 years) enrolled. High rates of overweight and obesity, (pre)hypertension and abnormal lipids were identified. Subjects with normal weight had more days of >60 minutes of physical activity compared with those with overweight or obesity (5.2 ± 2.4 vs. 3.8 ± 2.5 day; P = 0.07). Higher weight was correlated with higher factor consumption (cor = 0.88; P < 0.001). There was no difference in target joints based on weight category (30% in normal weight vs. 25% in overweight or obese, χ2 = 0.11, P = 0.74), which may be attributed to high rates of prophylaxis. CONCLUSIONS Modifiable risk factors for CVD were identified as part of the study during comprehensive clinic visits. The HTC team may develop behavioural interventions to target cardiovascular risk reduction as part of the comprehensive care model.
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