Patients with severe alpha-1 antitrypsin deficiency (AATD) have lower systolic and diastolic blood pressure, plasma triglycerides, remnant cholesterol, and a reduced risk of myocardial infarction and ischemic heart disease, according to a new study published in Respiratory Research.

Because AATD is associated with increased elastase activity, a team of researchers from Denmark hypothesised that the disease may be associated with reduced blood pressure and susceptibility to cardiovascular disease due to increased elasticity of the blood vessels and lower blood pressure.

The researchers recorded the baseline blood pressure and plasma lipids as well as cardiovascular events during follow-up of 91,353 randomly selected adults from the general population and 187 patients from the Danish AATD Registry. The researchers also genotyped the participants and found that 185 had the ZZ genotype, 207 had the SZ genotype, and 91,148 had the MM genotype, which is the normal genotype.

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The team of researchers found that AATD was associated with a decrease in systolic blood pressure of up to 5 mmHg and a decrease in diastolic blood pressure of up to 2 mmHg in patients with the ZZ genotype vs the SZ genotype vs the MM genotype. Patients with the ZZ genotype also had lower levels of plasma triglycerides and remnant cholesterol compared to patients with the MM genotype.

“Individuals with [AATD] had reductions of 2 and 5 mmHg in diastolic and systolic blood pressure, reduced risk of myocardial infarction, and a 34% lower risk of ischemic heart disease,” the researchers concluded.

When they summarized results for ischemic heart disease in meta-analysis with results from previous studies, they found that patients with AATD vs without the disease had an odds ratio of 0.66.

AATD is a rare inherited condition characterized by the deficiency of the alpha-1 antitrypsin enzyme, which normally protects the lung tissue from neutrophil elastase, one of the most destructive proteases in the body.


Winther SV, Ahmed D, Al-Shuweli S, et al. Severe α1-antitrypsin deficiency associated with lower blood pressure and reduced risk of ischemic heart disease: a cohort study of 91,540 individuals and a meta-analysis. Respir Res. 2022;23(1):55. doi:10.1186/s12931-022-01973-3