Individuals with severe α1-antitrypsin deficiency have increased elastase activity causing continuous degradation of elastin resulting in an early onset of COPD. It has been suggested, that the increased elastase activity over time also affects the elastic properties of the arterial walls, and thereby perhaps blood pressure and susceptibility to cardiovascular disease. We tested whether severe α1-antitrypsin deficiency affects blood pressure and susceptibility to cardiovascular disease in the general population.

We genotyped 91,429 individuals from the Copenhagen General Population Study and 190 patients with α1-antitrypsin deficiency from the Danish α1-antitrypsin deficiency registry and recorded blood pressure, plasma lipids and cardiovascular disease as outcomes.

In the combined study, α1-antitrypsin genotype was associated with stepwise decreases in systolic blood pressure and diastolic blood pressure of up to 4.5 mmHg for systolic blood pressure and up to 1.8 mmHg for diastolic blood pressure, in ZZ vs MM individuals (Ps for trend<0.05). We found that plasma triglycerides were significantly lower in ZZ compared with MM individuals (0.4 mmol/L, P<0.05); no other plasma lipids differed consistently by α1-antitrypsin genotype. Finally, there was no association between the α1-antitrypsin genotype and risk of ischemic heart disease, acute myocardial infarction, hypertension or ischemic cerebrovascular disease (Ps for trend>0.06).

In conclusion, we found that individuals with severe α1-antitrypsin deficiency vs MM individuals had lower systolic and diastolic blood pressures and reduced plasma triglycerides in the Danish general population.