α1-Antitrypsin deficiency and increased risk of atrial fibrillation in two large population-based cohorts

BACKGROUND: α1-Antitrypsin deficiency may affect heart tissue remodeling and susceptibility to atrial fibrillation. We hypothesised that α1-antitrypsin deficiency is associated with increased risk of atrial fibrillation.

STUDY DESIGN AND METHODS: In a nationwide nested study in Denmark, we identified 2233 individuals with α1-antitrypsin deficiency and 22 133 controls matched on sex, age and municipality. Further, in another population-based cohort we included 102 481 individuals from the Copenhagen General Population Study and an additional 187 individuals from the Danish α1-Antitrypsin Deficiency Registry. We recorded hospitalisations, digoxin medication use and deaths related to atrial fibrillation (contributing cause of death) during a median follow-up time of up to 67 years.

RESULTS: Individuals with versus without α1-antitrypsin deficiency had increased risk of hospitalisation due to atrial fibrillation in the nationwide cohort (adjusted hazard ratio (aHR) 1.99, 95% CI: 1.71-2.32) and in the population-based cohort (aHR 1.51, 95% CI: 1.09-2.09). Individuals with versus without α1-antitrypsin deficiency also had an increased risk of digoxin use (aHR 2.11, 95% CI: 1.42-3.14) in the nationwide cohort. Lastly, individuals with versus without α1-antitrypsin deficiency had increased risk of atrial fibrillation-related death in the nationwide cohort (aHR 2.60, 95% CI: 1.65-4.11).

CONCLUSION: Individuals with α1-antitrypsin deficiency have 2- to 3-fold increased risks of atrial fibrillation hospitalisation, digoxin use and atrial fibrillation-related mortality.