Departments of Respiratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden.
Int J Chron Obstruct Pulmon Dis. 2020 Jun 4;15:1245-1252. doi: 10.2147/COPD.S247377. eCollection 2020.
Severe alpha-1-antitrypsin deficiency (AATD) is an established risk factor for chronic obstructive pulmonary disease (COPD) and liver disease, but the effect on the incidence of ischemic heart disease (IHD) is not well known. The aim was to evaluate the risk of incident IHD in patients with severe AATD compared with a random sample of the general population, with known smoking habits.
AAT-deficient individuals, phenotype PiZZ (n=1545), were included in the Swedish National AATD Register. Controls (n=5883) were selected from population-based cohorts in Northern Sweden. Data on IHD and comorbidities were obtained by nationwide cross-linkage with the Swedish National Patient Register. Risk factors for incident IHD were analyzed using Cox regression, adjusted for age, gender, smoking status and the presence of COPD, hypertension, hyperlipidemia and diabetes.
At inclusion, 46% of the PiZZ individuals and 53% of the controls were never-smokers. During follow-up (median 16 years; range 0.2-23), 8% (n=123) of PiZZ individuals and 12% (n=690) of controls developed IHD. The controls had a significantly higher risk for incident IHD than the PiZZ individuals, with adjusted hazard ratio (HR) of 1.8 (95% CI 1.4-2.3). The risk was higher for controls in both ever-smokers (HR 2.1; 95% CI 1.5-2.9) and never-smokers (HR 1.5; 95% CI 1.1-2.2).
PiZZ individuals have a lower risk of developing incident ischemic heart disease than the control subjects with known smoking habits, who had been randomly selected from population-based cohorts.
严重的α-1-抗胰蛋白酶缺乏症（AATD）是慢性阻塞性肺疾病（COPD）和肝病的既定危险因素，但对缺血性心脏病（IHD）发病率的影响尚不清楚。目的是评估与具有已知吸烟习惯的普通人群的随机样本相比，严重 AATD 患者发生 IHD 的风险。
在瑞典全国 AATD 登记处纳入 AAT 缺陷个体表型 PiZZ（n=1545）。对照（n=5883）从瑞典北部的基于人群的队列中选择。通过与瑞典全国患者登记处的全国性交叉链接获得 IHD 和合并症的数据。使用 Cox 回归分析调整年龄、性别、吸烟状况以及 COPD、高血压、高血脂和糖尿病的存在后，分析发生 IHD 的危险因素。
在纳入时，46%的 PiZZ 个体和 53%的对照从未吸烟。在随访期间（中位数 16 年；范围 0.2-23），8%（n=123）的 PiZZ 个体和 12%（n=690）的对照发生了 IHD。与 PiZZ 个体相比，对照者发生 IHD 的风险明显更高，调整后的风险比（HR）为 1.8（95%CI 1.4-2.3）。在曾吸烟者（HR 2.1；95%CI 1.5-2.9）和从不吸烟者（HR 1.5；95%CI 1.1-2.2）中，对照者的风险更高。
与具有已知吸烟习惯的随机选择的基于人群的队列对照相比，PiZZ 个体发生缺血性心脏病的风险较低。
