Interstitial lung disease is a risk factor for ischaemic heart disease and myocardial infarction

Abstract

ObjectivesDespite many shared risk factors and pathophysiological pathways, the risk of ischaemic heart disease (IHD) and myocardial infarction (MI) in interstitial lung disease (ILD) remains poorly understood. This lack of data could be preventing patients who may benefit from screening for these cardiovascular diseases from receiving it.MethodsA population-based cohort study used electronic patient records from the Clinical Practice Research Datalink and linked Hospital Episode Statistics to identify 68 572 patients (11 688 ILD exposed (mean follow-up: 3.8 years); 56 884 unexposed controls (mean follow-up: 4.0 years), with 349 067 person-years of follow-up. ILD-exposed patients (pulmonary sarcoidosis (PS) or idiopathic pulmonary fibrosis (PF)) were matched (by age, sex, registered general practice and available follow-up time) to patients without ILD or IHD/MI. Rates of incident MI and IHD were estimated. HRs were modelled using multivariable Cox proportional hazards regression accounting for potential confounders.ResultsILD was independently associated with IHD (HR 1.85, 95% CI 1.56 to 2.18) and MI (HR 1.74, 95% CI 1.44 to 2.11). In all disease categories, risk of both IHD and MI peaked between ages 60 and 69 years, except for the risk of MI in PS which was greatest <50 years. Men with PF were at greatest risk of IHD, while women with PF were at greatest risk of MI.ConclusionsILD, particularly PF, is independently associated with MI and IHD after adjustment for established cardiovascular risk factors. Our results suggest clinicians should prioritise targeted assessment of cardiovascular risk in patients with ILD, particularly those aged 60–69 years. Further research is needed to understand the impact of such an approach to risk management.

Risk of acute myocardial infarction in sarcoidosis: A population-based cohort study from Sweden

“…3.2/1000 person-years), while HRs associated with sarcoidosis were increased in males but not females (1.6 vs. 0.9) [6]. It is unclear which factors contributed to the differences between our and the UK study.…”

“…Sarcoid inflammation appears to dysregulate lipid metabolism and accelerate atherosclerosis [3,4]. Whether these or other pathways lead to higher risks for acute myocardial infarction (AMI) in sarcoidosis compared to the general population remains unclear due to conflicting results in recent epidemiologic investigations [5,6]. Moreover, it is unclear whether AMI risk is uniformly increased or varies by age, sex, treatment, or time since sarcoidosis diagnosis.…”

Tissue fibroblasts are a critical source of prostacyclin and anti-thrombotic protection

“…For example, both chronic obstructive pulmonary disorder and interstitial lung disease feature dysfunction, damage, and phenotypic alterations to a range of lung parenchymal cells, including fibroblasts. An impairment of the ability of these non-vascular cells to produce prostacyclin could not only contribute to disease pathogenesis but also explain the marked increased in atherothrombotic risk observed in both conditions (Clarson et al, 2020;Feary et al, 2010). Indeed, lung tissue from chronic obstructive pulmonary disorder patients exhibits reduced prostacyclin synthase expression (Nana-Sinkam et al, 2007).…”

Lung transplantation for interstitial lung disease

“…Cardiovascular disease is common in ILD, probably due to inflammation, endothelial injury, lipid abnormalities and/or disease treatments [144,145]. CAD in particular has increased incidence in IPF and some CTDs including systemic lupus erythematosus and rheumatoid arthritis, where it is recognised as an important cause of mortality [144][145][146][147].…”

“…Cardiovascular disease is common in ILD, probably due to inflammation, endothelial injury, lipid abnormalities and/or disease treatments [144,145]. CAD in particular has increased incidence in IPF and some CTDs including systemic lupus erythematosus and rheumatoid arthritis, where it is recognised as an important cause of mortality [144][145][146][147]. The prevalence of CAD is as high as 68% in IPF patients undergoing cardiac catheterisation during a pre-transplant evaluation [133], and in patients referred for LTx, after adjustment for traditional risk factors fibrotic lung disease has been independently associated with increased CAD risk compared to other diagnoses [148].…”