Thanks to advances in treatment, people living with hemophilia A are living longer than ever before. Today, many people with hemophilia A who have access to proper care have life expectancies similar to those of people without the condition. With longer life comes the increased risk of age-related health conditions — including cardiovascular disease (CVD), or heart disease.

As the hemophilia A population ages, the number of people living with both hemophilia and heart disease is growing. Still, research on heart disease risk in people with hemophilia remains limited.

This article explores how hemophilia A may affect heart health, what factors can raise your risk for heart disease, and steps you can take to help protect your heart.

What Is Cardiovascular Disease?

Cardiovascular disease is the leading cause of death worldwide, according to the World Health Organization (WHO). CVD refers to problems with the heart and blood vessels and includes several conditions, such as:

• Heart attack — Blood flow to the heart is suddenly blocked.
• Stroke — Blood flow to the brain is blocked, usually by a blood clot.
• Ischemic heart disease — The heart’s arteries become narrowed, reducing blood and oxygen to the heart muscle.
• Heart failure — The heart can’t pump blood as well as it should.
• Arrhythmia — The heart beats with an irregular or abnormal rhythm.
• Heart valve disease — The heart valves don’t open or close properly, which affects normal blood flow.

Members of MyHemophiliaTeam have shared their diagnoses with different forms of CVD.

• “I found out I have a superficial venous thrombosis in my vein in my right arm.” (A superficial venous thrombosis is a blood clot in a vein close to the surface of the skin.)
• “My husband has been in and out of the hospital with a bad heart. He has an enlarged heart, scar tissue around his heart, and pericarditis.” (Pericarditis refers to inflammation of the pericardial layers around the heart.)
• “Just found out I have a pulmonary embolism.” (An embolism is a blood clot in the lung.)

Treatment for CVD

For most people, treatment for cardiovascular disease often involves medications called blood thinners. These include low-dose aspirin, heparin, and warfarin (sold under the brand name Coumadin). Blood thinners help lower the risk of thrombosis (blood clots forming in blood vessels).

However, these medications also increase the risk of bleeding, which can make treating heart disease more complex for people living with hemophilia A.

Some MyHemophiliaTeam members have been prescribed blood thinners due to clotting problems or CVD risk. One member shared, “I’m on blood thinners for the rest of my life because of the clotting that has caused heart attacks and extremely high blood pressure.”

In some cases, heart disease may require surgery. People with severe hemophilia A can have surgery safely when they receive expert medical care and appropriate treatment to manage bleeding.

CVD Risk Factors in People Living With Hemophilia A

People living with hemophilia may have the same risk factors for CVD as the general population, including:

• Hypertension (high blood pressure)
• High cholesterol levels
• Atherosclerosis (buildup of a fatty substance called plaque in the arteries)
• Diabetes
• Obesity
• Family history of CVD
• Older age
• Human immunodeficiency virus (HIV) infection
• A diet high in salt and fats
• Tobacco use
• Alcohol use

Studies show that people with hemophilia A have similar rates of diabetes and tobacco use as those without a bleeding disorder. However, hemophilia A may raise the risk of some other factors, such as high blood pressure.

Below, we’ll look at how certain cardiovascular risk factors affect people living with hemophilia A.

Hypertension

Hypertension is more common in people living with hemophilia than in the general population. Normal blood pressure is considered to be below 120/80 millimeters of mercury (mm Hg). High blood pressure is usually diagnosed when it’s over 130/80 mm Hg.

Having high blood pressure increases the risk of cardiovascular disease because it puts extra strain on the heart, blood vessels, and major organs — including the kidneys.

Research shows that hypertension tends to develop earlier in people with hemophilia and becomes more common with age. One study published in the journal Diagnostics found that men with hemophilia between ages 18 and 44 were about 2.5 times more likely to have high blood pressure than others in the same age group.

The reasons for this increased risk aren’t fully understood, but some researchers believe it may be linked to microbleeds in the kidneys, which are tiny amounts of bleeding that can damage kidney tissue over time.

Other factors that may contribute to kidney damage and high blood pressure in people with hemophilia include:

• HIV or hepatitis C (HCV) infection
• The medication tranexamic acid (often used to prevent bleeding)
• Chronic kidney disease, which is more common in people with hemophilia

People with hemophilia A are more likely to develop high blood pressure than those with hemophilia B. Risk is also higher in those with moderate hemophilia or who are living with HIV or HCV.

Atherosclerosis

Atherosclerosis happens when fats and cholesterol build up inside the arteries, forming plaque. Over time, this plaque can harden and narrow the arteries, blocking blood flow and raising the risk of blood clots.

Even though people with hemophilia A are less likely to form clots, they’re not protected from developing atherosclerosis. And because treating complications from atherosclerosis often involves blood-thinning medications — which increase bleeding risk — managing cholesterol levels becomes especially important for people living with hemophilia A.

Statins are a common type of medication used to lower cholesterol and reduce the risk of cardiovascular disease. Early lab research suggested that statins might reduce levels of factor VIII — the same clotting factor that’s absent or found in lower levels in people with hemophilia A.

However, a 2024 real-world study in Italy found that statin treatment appeared safe in people with hemophilia A who are at risk for heart disease. While more research is needed, current evidence suggests statins can be a safe and effective way to lower CVD risk in people living with hemophilia A.

If you have concerns about taking statins with hemophilia A, talk to your doctor. Never stop or change a prescribed medication without first speaking with your healthcare provider.

Reduced Mobility and Chronic Pain

Living with chronic pain can increase the risk of developing CVD. Studies estimate that between 40 percent and 70 percent of people with hemophilia experience chronic pain.

In hemophilia A, pain often results from hemorrhage (bleeding) into the joints and soft tissues. Over time, repeated bleeding can lead to joint damage, limited movement (reduced mobility), and long-term pain. These changes may affect a person’s ability to stay active, which is important for heart health.

Additionally, people with hemophilia A develop inhibitors — immune system antibodies that neutralize clotting factor treatments, making them less effective. People with inhibitors may be more likely to experience joint pain and reduced mobility.

HIV

Before 1992, blood products in the United States were not routinely screened for HIV. This put people with hemophilia at high risk of contracting HIV through blood transfusions or clotting factor treatments.

Thanks to advances in HIV treatment, many people who were exposed during that time are living longer, healthier lives.

Some older medications used to treat HIV have been linked to an increased risk of heart disease. However, today’s modern antiretroviral therapy (ART) and careful medical management can help reduce and manage this risk.

Does Hemophilia A Protect Against CVD?

Some early studies suggested that hemophilia A might offer some protection against certain types of CVD. The thinking was that lower levels of clotting factors might reduce the chance of harmful blood clots forming and blocking blood vessels.

For example, a 2022 study found that people with hemophilia had fewer CVD events, such as heart attacks and strokes, than expected when compared to the general population.

However, more recent research paints a more complex picture. A 2024 study in Circulation involving more than 7 million U.S. adult males found that people with hemophilia were actually more likely to have CVD risk factors and complications, including heart attack and stroke.

Researchers are still working to understand the full relationship between hemophilia and heart health. More studies and clinical trials are needed to clarify how hemophilia affects the risk of developing CVD.

Protecting Yourself From Cardiovascular Disease

CVD can be challenging to manage, but there are many ways to reduce your risk. Taking small, consistent steps can make a big difference in protecting your heart health:

• Work with your doctor to manage your blood pressure.
• Keep your cholesterol in a healthy range.
• Maintain a weight that supports your overall health.
• Limit saturated fat, salt (sodium), and added sugar in your diet.
• Aim for at least 150 minutes of physical activity each week.
• Avoid alcohol, or drink only in moderation.
• Quit smoking or using tobacco products.

Talk to Your Doctor About Heart Health

Make sure to check in regularly with your hematology team or primary care provider to talk about your heart health. They can help you understand how CVD may affect you and what steps you can take to prevent it.

Your doctor may recommend starting heart health screenings, such as blood pressure checks, earlier than people without a bleeding disorder. If your cholesterol or blood lipid levels are high, they may suggest statin medications to help lower your CVD risk.

If you do develop heart disease, you may benefit from care from a multidisciplinary team that includes a hematologist, a cardiologist, and possibly a nephrologist (a kidney specialist) if you have kidney complications.

Join the Conversation

On MyHemophiliaTeam, people share their experiences with hemophilia, get advice, and find support from others who understand.

Are you living with hemophilia and cardiovascular disease? Let others know in the comments below.