As our bleeding disorder population’s life expectancy continues to rise to that of the average American, our patients need to understand that they are at risk for the same disease states that over 50% of all Americans now experience. This is especially true considering providers are seeing an increased number of adults with a bleeding disorder that also have high cholesterol, high blood pressure, diabetes, obesity, and kidney or liver disease.
From an early age, our patients are told that their bleeding disorder causes their blood not to clot properly. While this is true, it does not immune our patients to cardiovascular events such as heart attacks and strokes. When we are talking about improper clotting from a bleeding disorder standpoint, we are talking about irregularities in the coagulation cascade. The coagulation cascade is activated when an injury to a blood vessel occurs. An unstable platelet plug is formed, and once the cascade is completed it stabilizes the plug that was originally formed. Whether the bleeding disorder is one that affects the platelets, one of the clotting factors, or von Willebrand factor, the platelet plug will not be able to be stabilized as quickly. This is why a person with a bleeding disorder bleeds longer than the average person and is generally at a lower risk for a DVT, pulmonary embolism or other clotting risks.
As people age, the arteries can harden and have a buildup of plaque. Plaque can start occurring in childhood and be just a thin layer of fat. As a person ages, this layer continues to grow upon itself. This is especially true if a person has too much LDL (bad) cholesterol and not enough HDL (good) cholesterol. As the layers build on each other, it can cause the arteries to narrow and limit blood flow. The narrowed arteries from plaque can lead to profound consequences such as heart attack, stroke, and aneurysms due to not having enough oxygen able to get to the area. Plaque can also create an injury to the vessel which can activate the clotting cascade and cause a clot. This blood clot can potentially travel to other areas of the body and cause problems such as pulmonary embolism (PE), heart attack, or stroke.
It is important for our patients to see their Primary Care Provider (PCP) on a yearly basis. At this annual exam, fasting labs should be drawn. These labs will show cholesterol levels and blood sugar levels as well as various other things that the provider will look at to determine overall health. The PCP will collaborate with the patient on how to manage health concerns and come up with a collaborative plan that allows the patient to live their best life well into their “golden” years.
