Arterial stiffness and microvascular changes in adult Egyptian patients with beta-thalassemia and sickle cell anemia: a case-control study

Abstract Background Endothelial dysfunction is a key contributor to cardiovascular complications in patients with thalassemia and sickle cell disease (SCD), this dysfunction is linked to early atherosclerosis development. This study aimed to assess macrovascular and microvascular changes using non-invasive techniques and correlate them with clinical and laboratory parameters. Methods This case-control study included 94 adult participants (32 SCD, 32 thalassemia, and 32 healthy controls) between July 2023 to December 2024. We assessed endothelial function using flow-mediated dilatation (FMD), carotid-femoral pulse wave velocity (CF-PWV), and nailfold capillaroscopy (NFC), alongside laboratory investigations. Results FMD was significantly reduced in patient groups compared to controls ( p = 0.015), while CF-PWV showed no significant difference ( p = 0.593). NFC revealed significantly lower capillary density in patients ( p < 0.001). Hydroxyurea use was associated with better capillary density ( p = 0.043). Conclusion Patients with SCD and thalassemia exhibit early endothelial dysfunction, particularly at the microvascular level. NFC and FMD may serve as useful non-invasive tools for early detection, and hydroxyurea may have a protective vascular role.