Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPD
Paul Ellis,1,2 Emily Bailey,2 Radmila Choate,3 Kristen E Holm,4,5 Robert A Sandhaus,5,6 Alice M Turner,1,2 Michael Newnham1,2 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK; 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 3University of Kentuck...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2024-01-01
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| Series: | International Journal of COPD |
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| Online Access: | https://www.dovepress.com/prevalence-of-cardiovascular-disease-and-rate-of-major-adverse-cardiov-peer-reviewed-fulltext-article-COPD |
| _version_ | 1797353800277688320 |
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| author | Ellis P Bailey E Choate R Holm KE Sandhaus RA Turner AM Newnham M |
| author_facet | Ellis P Bailey E Choate R Holm KE Sandhaus RA Turner AM Newnham M |
| author_sort | Ellis P |
| collection | DOAJ |
| description | Paul Ellis,1,2 Emily Bailey,2 Radmila Choate,3 Kristen E Holm,4,5 Robert A Sandhaus,5,6 Alice M Turner,1,2 Michael Newnham1,2 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK; 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 3University of Kentucky College of Public Health, Lexington, KY, USA; 4Division of Neurology and Behavioural Health, National Jewish Health, Denver, CO, USA; 5AlphaNet, Kissimmee, FL, USA; 6Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USACorrespondence: Paul Ellis, Email p.ellis@bham.ac.ukAim: 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.Keywords: chronic obstructive pulmonary disease, COPD, alpha-1 antitrypsin deficiency, AATD, cardiovascular disease |
| first_indexed | 2024-03-08T13:36:11Z |
| format | Article |
| id | doaj.art-4476f30b272c41f0a006e4a64691661e |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-03-08T13:36:11Z |
| publishDate | 2024-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-4476f30b272c41f0a006e4a64691661e2024-01-16T18:04:31ZengDove Medical PressInternational Journal of COPD1178-20052024-01-01Volume 1914915989754Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPDEllis PBailey EChoate RHolm KESandhaus RATurner AMNewnham MPaul Ellis,1,2 Emily Bailey,2 Radmila Choate,3 Kristen E Holm,4,5 Robert A Sandhaus,5,6 Alice M Turner,1,2 Michael Newnham1,2 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK; 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 3University of Kentucky College of Public Health, Lexington, KY, USA; 4Division of Neurology and Behavioural Health, National Jewish Health, Denver, CO, USA; 5AlphaNet, Kissimmee, FL, USA; 6Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USACorrespondence: Paul Ellis, Email p.ellis@bham.ac.ukAim: 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.Keywords: chronic obstructive pulmonary disease, COPD, alpha-1 antitrypsin deficiency, AATD, cardiovascular diseasehttps://www.dovepress.com/prevalence-of-cardiovascular-disease-and-rate-of-major-adverse-cardiov-peer-reviewed-fulltext-article-COPDchronic obstructive pulmonary diseasecopdalpha-1 antitrypsin deficiencyaatdcardiovascular disease |
| spellingShingle | 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 International Journal of COPD chronic obstructive pulmonary disease copd alpha-1 antitrypsin deficiency aatd cardiovascular disease |
| title | Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPD |
| title_full | Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPD |
| title_fullStr | Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPD |
| title_full_unstemmed | Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPD |
| title_short | Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPD |
| title_sort | prevalence of cardiovascular disease and rate of major adverse cardiovascular events in severe alpha 1 antitrypsin deficiency copd |
| topic | chronic obstructive pulmonary disease copd alpha-1 antitrypsin deficiency aatd cardiovascular disease |
| url | https://www.dovepress.com/prevalence-of-cardiovascular-disease-and-rate-of-major-adverse-cardiov-peer-reviewed-fulltext-article-COPD |
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