Prevalence of cardiovascular disease and rate of major adverse cardiovascular events in severe alpha-1 antitrypsin deficiency COPD.
Author
Ellis, PaulBailey, Emily
Choate, Radmila
Holm, Kristen E
Sandhaus, Robert A
Turner, Alice M
Newnham, Michael
Publication date
2024-01-17
Metadata
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Aim: Alpha-1 antitrypsin deficiency is an autosomal co-dominant condition that predisposes individuals to early-onset emphysema. As with COPD, AATD-COPD is associated with pulmonary exacerbations, which impacts on overall mortality and quality of life. Though there is evidence that COPD is associated with a higher prevalence of cardiovascular disease and major adverse cardiovascular events (MACE), it is unclear if this is true for patients with AATD-COPD. Methods: Prevalence of cardiovascular disease was determined in two separate severe AATD cohorts: AlphaNet, USA and the Birmingham AATD registry, UK. All patients had preexisting lung disease. Cardiovascular disease was defined as presence of any of the following: heart failure, ischaemic heart disease, atrial fibrillation, stroke, and myocardial infarction. A Cox proportional hazards model was used to assess the impact of prior cardiovascular disease and frequent exacerbator phenotype on risk of future MACE. Results: Out of 3493 patients with severe AATD, 14.7% had prior cardiovascular disease, including stroke (2.3%), myocardial infarction (2.2%), and heart failure (2.5%). Frequent exacerbators were more likely to have preexisting cardiovascular disease compared with those with one or no exacerbations in the preceding year (63% vs 44.8%, p = 0.001). There was increased risk of future MACE in frequent exacerbators (HR 1.85, 95% CI 1.24 to 2.75), former and current smokers (HR 1.80, 95% CI 1.07 to 3.02, p = 0.026, and HR 4.04, 95% CI 1.44 to 11.32, p = 0.008, respectively), and those with prior cardiovascular disease (HR 3.81, 95% CI 2.60 to 5.58, p < 0.001). Conclusion: In severe AATD-COPD, MACE are associated with an increased exacerbation frequency, previous cardiovascular disease, and a history of smoking.Citation
Ellis P, Bailey E, Choate R, Holm KE, Sandhaus RA, Turner AM, Newnham M. Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPD. Int J Chron Obstruct Pulmon Dis. 2024 Jan 17;19:149-159. doi: 10.2147/COPD.S419846.Type
ArticleAdditional Links
http://www.dovepress.com/articles.php?journal_id=6PMID
38249829Publisher
Taylor and Francis Groupae974a485f413a2113503eed53cd6c53
10.2147/COPD.S419846