alpha(1) -antitrypsin Z allele and risk of venous thromboembolism in the general population

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J Thromb Haemost. 2021 Oct 18. doi: 10.1111/jth.15556. Online ahead of print.


BACKGROUND: The α1 -antitrypsin Z (rs28929474) allele may lead to alterations in hemostasis either through liver disease or effects on coagulation factors.

OBJECTIVES: To test the hypothesis that the α1 -antitrypsin Z genetic variant is associated with increased risk of venous thromboembolism.

METHODS: 107075 individuals from the Copenhagen General Population Study (CGPS) were used to test the association of the α1 -antitrypsin Z genetic variant with risk of venous thromboembolism, including deep venous thrombosis and pulmonary embolism, prospectively. Confirmatory analyses were done in the UK Biobank.

RESULTS: During follow-up, venous thromboembolism was diagnosed 6649 times in non-carriers, 436 times in heterozygotes, and 10 times in homozygotes. Hazard ratios for venous thromboembolism in α1 -antitrypsin Z heterozygotes and homozygotes versus non-carriers were 1.1 (95% confidence interval, 1.0-1.2) and 2.2 (1.3-3.7). A one Z allele increase was associated with a hazard ratio for venous thromboembolism of 1.2 (1.0-1.3). The corresponding odds ratio in the UK Biobank was 1.2 (1.1-1.3). The absolute risk of venous thromboembolism associated with α1 -antitrypsin ZZ homozygosity was 7.8% (3.6-12.1). The corresponding estimates were 20.1% (9.1-31.2) for prothrombin G20210A and 15.0% (12.6-17.4) for factor V Leiden. The fraction of venous thromboembolic events attributable to the α1 -antitrypsin Z allele was 0.7% (0.1-1.3). For the prothrombin G20210A and factor V Leiden mutations, population attributable fractions were 1.2% (0.9-1.6) and 10.5% (9.9-11.1).

CONCLUSION: In conclusion, α1 -antitrypsin ZZ homozygosity was associated with a 2.2-fold risk of venous thromboembolism and had a comparable population attributable fraction to prothrombin G20210A.

PMID:34662507 | DOI:10.1111/jth.15556