Risk Factors for Cardiovascular Disease in People With Idiopathic Pulmonary Fibrosis

Abstract

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

Chronic Kidney Disease Predicts Survival in Patients with Idiopathic Pulmonary Fibrosis

“…Pulmonary hypertension and obstructive sleep apnea are frequent comorbidities of IPF, and a link between CKD and these conditions has been reported [31,32] . Additionally, recent epidemiologic studies have revealed that patients with IPF had an increased risk of hypertension, diabetes mellitus, and cardiovascular disease [7,14,18,19] , all of which are closely associated with CKD. Moreover, there may be mechanistic links between CKD and IPF, such as cellular senescence and oxidative stress [33,34] .…”

“…IPF has risk factors for CKD similar to COPD, such as old age and smoking. Moreover, recent studies have reported that patients with IPF have an increased risk of hypertension, diabetes mellitus, and cardiovascular disease, and that these comorbid conditions may be associated with increased mortality [14,18,19] .…”

Changing causes of death for patients with chronic respiratory disease in England, 2005-2015

“…A validated COPD code list34 was the basis of our COPD code list (see online supplement for additional codes). The code lists used to identify patients with bronchiectasis12 and ILD35 are published.…”

Respiratory diseases and vascular failure

“…It was found that the rate of first-time CAD events was significantly higher in the patients with IPF than in the control subjects (RR: 2.32); however, the incidence of stroke was only marginally higher for IPF. A high prevalence of coronary risk factors in IPF did not fully account for the increased risk of CAD, suggesting that IPF itself was a specific risk factor for CAD 40) .…”