Association Between Pulmonary Fibrosis and Coronary Artery Disease

Rationale & ObjectivePeople with idiopathic pulmonary fibrosis (IPF) have been shown to be at an increased risk of cardiovascular disease but reasons for this are unknown. The aim of this study was to compare the prevalence of common cardiovascular risk factors in people with IPF and the general population and establish the incidence of ischaemic heart disease (IHD) and stroke after the diagnosis of IPF, controlling for these risk factors. MethodsWe used data from a large United Kingdom primary care database to identify incident cases of IPF and matched general population controls. We compared the prevalence of risk factors for cardiovascular disease and prescription of cardiovascular medications in people with IPF (before diagnosis) with general population controls, and assessed the incidence of IHD and stroke in people with IPF (after diagnosis) compared to controls. ResultsWe identified 3,211 cases of IPF and 12,307 controls. Cases with IPF were more likely to have a record of hypertension (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.19 -1.44), and diabetes (OR 1.20, 95% CI 1.07 -1.34) compared with controls; they were also more likely to have been prescribed several cardiovascular drugs. The rate of first time IHD events was more than twice as high in cases compared to controls (rate ratio [RR] 2.32, 95% CI 1.85-2.93; p<0.001) but the incidence of stroke was only marginally higher (p=0.09). Rate ratios for IHD and stroke were not altered substantially after adjusting for cardiovascular risk factors. 2 ConclusionSeveral cardiovascular risk factors were more prevalent in people with IPF; however this did not account for the increased rate of IHD in this group of patients. Abstract word count 257

Section: Discussionsupporting

confidence: 87%

Risk Factors for Cardiovascular Disease in People With Idiopathic Pulmonary Fibrosis

Dalleywater

Powell

Hubbard

et al. 2015

“…Clinical progression of IPF preceded death in 47% (16/34) of patients (see Table 4 ). While the optimal therapy for IPF remains yet to be identifi ed, the effectiveness of treatment strategies targeting the longitudinal interactions among prevalent comorbid conditions such as pulmonary hypertension, gastroesophageal refl ux, and cardiovascular risk factors [19][20][21][22] on the prevention of primary or non-IPF respiratory exacerbations needs further research.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Prevalence, and Clinical Course of Idiopathic Pulmonary Fibrosis

Pérez

Daniels

Schroeder

et al. 2010

415

187

Background: Limited data exist regarding the population-based epidemiology of idiopathic pulmonary fi brosis (IPF). The objective of the study was to describe the trends in the incidence, prevalence, and clinical course of IPF in the community. Methods:We conducted a population-based study of adult patients with IPF in Olmsted County, Minnesota, from 1997 to 2005. Two methods were used to identify IPF cases, as defi ned by the 2002 American Thoracic Society/European Respiratory Society consensus statement: (1) usual interstitial pneumonia (UIP) on a surgical lung biopsy specimen or a defi nite UIP pattern on a high-resolution CT image (narrow criteria) and (2) UIP on a surgical lung biopsy specimen or a defi nite or possible UIP pattern on CT image (broad criteria). Results: Of 596 patients screened for the possibility of pulmonary disease or pulmonary fi brosis over 9 years of follow-up, 47 cases had IPF. Of these, 24 met the narrow criteria. The age-and sex-adjusted incidence was 8.8/100,000 and 17.4/100,000 person-years, for narrow and broad criteria, respectively. The age-adjusted incidence was higher in men than in women, and among patients aged 70-79 years. During the study period, the incidence of IPF decreased ( P , .001). On December 31, 2005, the age-and sex-adjusted prevalence was 27.9/100,000 and 63/100,000 persons by narrow and broad criteria, respectively. Thirty-seven patients experienced a total of 53 respiratory exacerbations (26 IPF related, 27 non-IPF related), and 34 (72%) patients died. The primary cause of death was IPF related in 16 (47%) patients. Median survival for narrow-criteria and broad-criteria incidence cases was 3.5 and 4.4 years, respectively. Conclusions: The incidence of IPF in Olmsted County decreased over the study period. Nonprimary IPF respiratory exacerbations are as frequent as primary IPF respiratory exacerbations and an important cause of death.CHEST 2010; 137( 1 ):129-137Abbreviations: ATS/ERS 5 American Thoracic Society and European Respiratory Society; HRCT 5 high-resolution computed tomography; IPF 5 idiopathic pulmonary fi brosis; REP 5 Rochester Epidemiology Project; UIP 5 usual interstitial pneumonia

“…71 Vascular or coronary artery disease, obstructive sleep apnea, diabetes, [71][72][73][74] corticosteroid-associated osteoporosis, and sarcopenia are commonly observed in patients with IPF. [75][76][77][78][79][80][81] The incidence of and mortality risk associated with pulmonary hypertension (PH), a common feature of advanced IPF, increases in individuals . 60 years of age.…”

Section: Treatmentmentioning

confidence: 99%

Workshop on Idiopathic Pulmonary Fibrosis in Older Adults

Castriotta

Eldadah

Foster

et al. 2010

T he aging lung loses mass and undergoes several functional and structural changes ( Table 1 ). Lung function declines with age, as shown by changes in gas exchange and airfl ow limitation ( Fig 1 ). Older adults, defi ned as those aged Ն 60 years, become more rapidly limited during exercise, and 50% of adults . 70 years of age become exercise-limited by dyspnea, compared with only 20% of younger adults. Abbreviations: EBV 5 Epstein-Barr virus; EMT 5 epithelial-mesenchymal transition; ER 5 endoplasmic reticulum; GERD 5 gastroesophageal refl ux disease; IPF 5 idiopathic pulmonary fi brosis; MSC 5 mesenchymal stem cell; PH 5 pulmonary hypertension; SP-C 5 surfactant protein C; TERT 5 telomerase reverse transcriptase; TGF-b 5 transforming growth factor b ; UIP 5 usual interstitial pneumonia