Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPD

Figures & data

Table 1 Baseline Characteristics

	Overall	No CVD	CVD	P
N	3493	2980	513
AAT augmentation	2561 (67.9)	2114 (70.9)	417 (81.3)
Age (years)	50.7 (10.9)	50.3 (10.8)	53.2 (11.6)	<0.001
Male (%)	1845 (52.8)	1557 (52.2)	288 (56.1)	0.113
Smoking status (%)				0.574
Current	123 (3.7)	107 (3.7)	16 (3.2)
Former	2342 (69.8)	2000 (70.0)	342 (68.5)
Never	891 (26.5)	750 (26.3)	141 (28.3)
BMI	26.38 (5.85)	26.32 (5.73)	26.70 (6.50)	0.191
FEV1% predicted	50.44 (25.67)	50.63 (25.82)	49.18 (24.65)	0.398
Exacerbation/year^+	1.00 [0.00, 4.00]	1.00 [0.00, 3.00]	2.00 [1.00, 4.00]	<0.001
Major cardiovascular disease* (%)	513 (14.7)	–	–
Myocardial infarction	78 (2.2)	–	–
Ischaemic heart disease	54 (5.8)	–	–
Heart failure	87 (2.5)	–	–
Stroke	79 (2.3)	–	–
Atrial fibrillation	308 (8.8)	–	–
Hypertension (%)	1121 (32.1)	878 (29.5)	243 (47.4)
Hypercholesterolaemia^^ (%)	120 (12.9)	85 (10.2)	35 (36.5)
Medications related to CVD
Antihypertensives	498 (19.4)	378 (17.6)	120 (28.8)	<0.001
Anti-platelets	316 (12.3)	228 (10.6)	88 (21.1)	<0.001
Statins	280 (10.9)	218 (10.2)	62 (14.9)	0.006
β-blockers	111 (4.3)	66 (3.1)	45 (10.8)	<0.001
Diuretics	136 (5.3)	95 (4.4)	41 (9.8)	<0.001
Anti-arrhythmia	76 (3.0)	30 (1.4)	46 (11.0)	<0.001
Anticoagulation	64 (2.5)	36 (1.7)	28 (6.7)	<0.001

Notes: *Percentages do not add up to 14.7% as some patients had more than one cardiovascular disease at baseline. ^{^}Data only available from Birmingham AATD registry. ⁺In year before baseline assessment.

Abbreviations: AAT, alpha-1 antitrypsin; BMI. body mass index; FEV₁. forced expiratory volume in 1 second; CVD. cardiovascular disease.

Table 2 Baseline Characteristics of Grouped by Patients with and without MACE During Follow-Up Period

	No MACE	MACE	P
n	2722	122
Age (years)	55.7 (10.3)	57.4 (10.80)	0.071
Male (%)	1427 (52.4)	72 (59.0)	0.182
Smoking status (%)			0.040
Current smoker	87 (3.3)	5 (4.2)
Ex smoker	1846 (70.3)	95 (79.8)
Non-smoker	692 (26.4)	19 (16.)
FEV1% baseline	47.3 (21.3)	46.1 (24.1)	0.572
Frequent exacerbator (≥2/year) (%)	1220 (44.8)	77 (63.1)	<0.001
Exacerbation frequency	1.00 [0.00, 4.00]	2.00 [1.00, 4.00]	0.001
Major cardiovascular disease (%)	407 (15.0)	54 (43.4)	<0.001
Stroke	48 (1.8)	6 (5.0)	0.029
Myocardial infarction	54 (2.0)	16 (13.4)	<0.001
Atrial fibrillation	260 (9.6)	24 (19.7)	<0.001
Heart failure	61 (2.3)	16 (13.4)	<0.001
Hypertension (%)	925 (34.0)	60 (49.2)	0.001
Diabetes (%)	138 (5.1)	12 (9.8)	0.036
Follow-up (days)	1522 [718, 2955]	1053 [507, 1887]	<0.001

Notes: Missing data as follows: exacerbation frequency, 6.6%; FEV₁% baseline, 44.9%; smoking status, 3.5%.

Abbreviations: AAT, alpha-1 antitrypsin deficiency; FEV₁, forced expiratory volume second⁻¹; MACE, major adverse cardiovascular events; SD, standard deviation.

Figure 1 Flow diagram for study participants.

Figure 2 Cox proportional hazard model for MACE incidence adjusted for annual exacerbation frequency (<2 or 2 or more exacerbations/year), age, sex, smoking status, previous cardiovascular disease, hypertension, and diabetes.