The Effect of Cardiovascular Medications on Disease-Related Outcomes in Idiopathic Pulmonary Fibrosis: A Systematic Review and Meta-Analysis

Abstract

Background: Multiple studies have revealed that idiopathic pulmonary fibrosis (IPF) patients are more at risk for cardiovascular diseases and that many IPF patients receive cardiovascular medications like statins, angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), and anticoagulants. Existing studies have reported divergent findings on the link between cardiovascular medications and fibrotic disease processes. The aim of this study is to synthesize the evidence on the efficacy of cardiovascular medications in IPF.Methods: We searched studies reporting the effect of cardiovascular medications on IPF in the PubMed, Embase, Web of Science, Cochrane Library, and two Chinese databases (China National Knowledge Infrastructure database and China Wanfang database). We calculated survival data, forced vital capacity (FVC) decline, and IPF-related mortality to assess the efficacy of cardiovascular medications in IPF. We also estimated statistical heterogeneity by using I2 and Cochran Q tests, and publication bias was evaluated by risk of bias tools ROBINS-I.Results: A total of 12 studies were included in the analysis. The included studies had moderate-to-serious risk of bias. Statin use was associated with a reduction in mortality (hazard ratio (HR), 0.89; 95% CI 0.83–0.97). Meta-analysis did not demonstrate any significant relationship between statin use and the FVC decline (HR, 0.86; 95% CI 0.73–1.02), ACEI/ARB use, and survival data (HR, 0.92; 95% CI 0.73–1.15) as well as anticoagulant use and survival data (HR, 1.16; 95% CI 0.62–2.19).Conclusion: Our study suggested that there is a consistent relationship between statin therapy and survival data in IPF population. However, there is currently insufficient evidence to conclude the effect of ACEI, ARB, and anticoagulant therapy on IPF population especially to the disease-related outcomes in IPF.

Left-sided heart failure burden and mortality in idiopathic pulmonary fibrosis: a population-based study

“…The underlying explanation is more likely multifactorial, including increased screening and treatment for cardiovascular risk factors in clinical practice. Interestingly, both in vitro and in vivo studies have shown some antifibrotic properties of commonly used cardiovascular medications including ACE inhibitors, angiotensin receptor antagonists, mineralocorticoid receptor antagonists and angiotensin receptor neprilysin inhibitors [ 40 , 41 ], although this has rarely translated to improved outcomes in clinical trials. A limitation of the study however is that use of cardiovascular medications was not adjusted for in the mortality analyses, with this necessitating future work to characterise further any potential modulation of cause-specific mortality risk by cardiovascular medication use in patients with IPF and comorbid left-sided HF.…”