Alpha-1 antitrypsin deficiency and cardiovascular disease: a review.

The genetic disease α1-antitrypsin deficiency is best known to cause an early onset of chronic obstructive pulmonary disease due to an increased activity of the proteolytic enzyme elastase, and to cause increased risk of liver cirrhosis due to misfolding and polymerization of α1-antitrypsin in the liver. Research within recent years is pointing towards α1-antitrypsin deficiency being more of a systemic disease, affecting organ systems beyond the lungs and liver. It is well-established that the extracellular matrix in tissues of the cardiovascular system is comprised of elastic fibers, suggesting that these could be affected by the increased elastase activity, thereby affecting the susceptibility to cardiovascular disease in individuals with α1-antitrypsin deficiency. This paper reviews the possible associations between α1-antitrypsin deficiency and cardiovascular disease and finds that α1-antitrypsin deficiency seems to be associated with lower systolic blood pressure, reduced risk of ischemic heart disease, increased risk of heart failure and increased risk of atrial fibrillation. In conclusion, the review found that α1-antitrypsin deficiency is likely associated with cardiovascular disease, most of which can be prevented or treated if diagnosed in affected patients.