The CACHE Study: Coronary Artery Care in HaEmophilia
Trial ID: NCT06706206
Status: RECRUITING
Study type: OBSERVATIONAL
Start date: 2025-02-25
Completion date: 2032-01
Sponsor: Oxford University Hospitals NHS Trust
Conditions: Haemophilia; Cardiovascular Diseases
Interventions: Observational trial
Locations: Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust
Countries: United Kingdom
Enrollment: 80
Age range: 45 Years - 120 Years
Sex: MALE

Summary:
The investigators will use state-of-the-art imaging to look at heart disease in people with haemophilia. Haemophilia is an inherited disorder in which blood does not clot properly because of lack of a key 'glue' blood component (chemicals known as factor VIII or IX). People with haemophilia are 40% less likely to die of heart disease, but it is not known exactly why this is. Understanding heart disease in people with haemophilia is important because better treatments for haemophilia mean that these patients are now living longer, but doctors still don't know if the risk for heart disease in these patients as they age is the same as that for the general population. If these processes are better understand (perhaps less blood clotting is actually protecting the heart from blockage-causing clots), scientists might be able to reduce the risk of heart attacks for everybody.

The UK's first photon-counting detector cardiac CT scanner generates detailed images of the heart and its blood vessels by counting individual X-ray photons. Together with artificial intelligence tools, it is possible to extract a lot of information from these images. As people age, fat is deposited in the vessels which supply blood to the heart which forms plaques. Plaques cause narrowing of the vessels, reducing blood flow to the heart, and can also burst (rupture), leading to a blood clot and heart attack. The new CT scan will show the type and amount of plaques, and quantify the risk of plaque rupture, in people with haemophilia; and the investigators will compare this to people without haemophilia.

Understanding the role of factor VIII/IX in heart attacks will improve management of heart disease in people with haemophilia, and may also lead to new prevention and treatment strategies that benefit heart health for everyone.

Eligibility criteria:
Inclusion Criteria:

* Be willing and able to give informed consent for participation in the study.
* Male, aged 45 years or above (no upper age limit).
* Haemophilia A or B with Factor VIII/IX less than 40% (0.40 IU/ml).

Exclusion Criteria:

* Participants unable or unwilling to give informed consent.
* Participants unable to understand the English language.
* Participants unable or unwilling to attend for the necessary scans and investigations.
* Patients with absolute contra-indications to CT imaging will be excluded from the study. This includes:

  * Any known contraindications to CT iodinated Contrast.
  * Significant renal impairment (eGFR \<30 ml/min).
* Any other medical conditions which would influence the reliability of the study results determined by the investigators.

Outcomes:
Occurrence of coronary artery disease detected by coronary CT angiogram among people with haemophilia (PWH) versus control group.