Pocoski J, Ma A, Kessler C M, Boklage S, Humphries T J
Global Health Economics and Outcomes Research, Bayer HealthCare, Whippany, NJ, USA.
Haemophilia. 2014 Jul;20(4):472-8. doi: 10.1111/hae.12339. Epub 2013 Nov 29.
There is conflicting evidence in the literature on whether individuals with haemophilia in the USA have greater, reduced, or similar risks for cardiovascular disease as the general population. This study evaluated the prevalence of cardiovascular comorbidities among USA males with haemophilia A, relative to an unaffected general male population with similar characteristics. Males with haemophilia A and continuous insurance coverage were identified by ICD-9-CM code 286.0 (1 January 2007-31 December 2009) using the MarketScan Commercial and Medicare Research Databases. Individuals with haemophilia A were exact matched 1:3 with males without a diagnosis of haemophilia A. The prevalence of cardiovascular comorbidities identified by ICD-9-CM code was determined for matched cohorts. Of the study population, 2506 were grouped in the haemophilia A cohort and 7518 in the general cohort. Proportions of individuals with haemorrhagic stroke (2.0% vs. 0.5%, P < 0.001), ischemic stroke (4.7% vs. 2.7%, P < 0.001), coronary artery disease (10.7% vs. 5.8%, P < 0.001), myocardial infarction (0.8% vs. 0.3%, P = 0.003), hypertension (22.6% vs. 15.5%, P < 0.001), hyperlipidaemia (15.9% vs. 11.9%, P < 0.001), arterial thrombosis (12.1% vs. 5.9%, P < 0.001), and venous thrombosis (4.4% vs. 1.1%, P < 0.001) were significantly greater for the haemophilia A cohort. Results were consistent across most age groups, and comorbidities appeared at an earlier age in those with haemophilia A than in the general population. Among the USA haemophilia A population cardiovascular comorbidities are more prevalent and they appear earlier in life in comparison to the general male population, suggesting the need for earlier, enhanced screening for age-related comorbidities in the haemophilia community.
关于美国血友病患者患心血管疾病的风险是高于、低于还是与普通人群相似，文献中的证据相互矛盾。本研究评估了美国甲型血友病男性患者相对于具有相似特征的未受影响普通男性人群中心血管合并症的患病率。使用MarketScan商业和医疗保险研究数据库，通过ICD - 9 - CM编码286.0（2007年1月1日至2009年12月31日）识别出有持续保险覆盖的甲型血友病男性患者。甲型血友病患者与未诊断出甲型血友病的男性按1:3精确匹配。确定匹配队列中由ICD - 9 - CM编码识别的心血管合并症的患病率。在研究人群中，2506人被归入甲型血友病队列，7518人被归入普通队列。甲型血友病队列中出血性中风（2.0%对0.5%，P < 0.001）、缺血性中风（4.7%对2.7%，P < 0.001）、冠状动脉疾病（10.7%对5.8%，P < 0.001）、心肌梗死（0.8%对0.3%，P = 0.003）、高血压（22.6%对15.5%，P < 0.001）、高脂血症（15.9%对11.9%，P < 0.001）、动脉血栓形成（12.1%对5.9%，P < 0.001）和静脉血栓形成（4.4%对1.1%，P < 0.001）的患者比例显著更高。结果在大多数年龄组中一致，并且甲型血友病患者的合并症出现年龄比普通人群更早。在美国甲型血友病人群中，心血管合并症更为普遍，且在生命早期出现，这表明需要在血友病群体中对与年龄相关的合并症进行更早、更强化的筛查。
