Cardio Care

Treating heart disease in people with bleeding disorders
Author: Matt McMillen

New cholesterol guidelines published last year, developed jointly by the American College of Cardiologists and the American Heart Association, indicate that nearly half of adults between the ages of 40 and 75 are now eligible to take statins, ­cholesterol-lowering drugs. That number includes everyone diagnosed with heart disease, maybe even you.

In the past, it was believed that hemophilia protected people from heart disease. But recent data disprove that. “There may be a little bit of protection, but we now know that individuals with hemophilia do get heart disease and have heart attacks,” says Barbara Konkle, MD, a hematologist in the Hemophilia Care Program at the Puget Sound Blood Center in Seattle.

What is heart disease?

Heart disease is the leading cause of death for men and women in the US. It occurs when a waxy substance called plaque accumulates on artery walls in your heart, preventing blood from pumping efficiently. Atherosclerosis, or hardening of the arteries, occurs slowly, often taking years to produce symptoms.

Plaque buildup may start when the arteries in your heart are damaged by smoking, high blood pressure, high cholesterol and fat in the blood. High blood sugar levels, common in diabetes, are another contributor. Other heart disease risk factors include advancing age, obesity, physical inactivity and stress.

Symptoms of heart disease include:

Angina, or chest pain, due to a lack of oxygen-rich blood reaching your heart. Angina also causes pain in your shoulders, arms, neck, jaw or back. It often increases with activity and eases when you relax.

Shortness of breath results when heart disease has progressed to heart failure. When your heart can no longer pump a sufficient amount of blood throughout your body, your lungs start to fill with fluid, a ­con­dition called congestive heart failure. That makes it increasingly difficult to breathe.

Heart attack is also a symptom of heart disease. It strikes when plaque in your arteries ruptures and blocks the flow of blood to your heart. Chest pain, shortness of breath and upper body discomfort all can be signals of a heart attack. Women most frequently experience shortness of breath, nausea and vomiting, and pain in their jaw or back. These symptoms should be taken seriously, as heart attacks can be fatal.

Treating heart disease

Managing treatments can be tricky for people with hemophilia and heart disease, says Konkle. After all, heart disease is commonly treated with blood thinners, or anticoagulants, and medications that inhibit blood platelets. Some men with hemophilia can tolerate such medications without bleeding, but others cannot, according to Konkle. Statins, on the other hand, are not generally a problem and are used in many men with hemophilia, she says.

Aspirin, which inhibits blood platelets, should be considered on a case-by-case basis. To use it, some patients will need to treat with factor, while others may do fine without it, Konkle says. “We don’t have enough data to say what works best,” she says. “So at this point, we just have to individualize for each patient.”

Ideally, your doctors will help you reduce your need for blood thinners and other medications that complicate hemophilia. Atrial fibrillation, the most common arrhythmia (irregular heartbeat), sometimes can be treated by catheter ablation, a minimally invasive procedure that stops the erratic electrical impulses. If successful, you may no longer need blood thinners, such as warfarin.

Healthier hearts

If you have heart health issues, one significant advantage you have is the comprehensive care you receive at your hemophilia treatment center (HTC). The staff can work closely with your primary care physician and cardiologist. “Use your HTC as a resource. There, people with hemophilia who also have heart disease will have a lot of support in their efforts to live a healthier lifestyle through diet and exercise,” Konkle says. “This can result in multiple benefits beyond heart disease, including reducing joint disease and symptoms.”

Heart protection begins with you, the patient. Often it means making lifestyle changes, such as maintaining an ideal weight, getting regular exercise and eating a healthy diet, says Konkle. “The best thing is to lead a heart-healthy life and not have to use medications that increase bleeding risks,” Konkle says. “We should all do that, but it’s especially important for people with hemophilia because of the challenges of ­treatment.”