Pulmonary Fibrosis Increases Heart Disease Risk, Real-world Data Suggest

Patients with interstitial lung disease (ILD), including pulmonary fibrosis (PF), have an increased risk of coronary heart disease and heart attack, compared to those without these lung conditions, a recent study suggests.

Clinicians should take these findings into account, and screen patients with ILDs, especially those 60–69 years old, for cardiovascular problems to assess their risk for future cardiac events, the researchers advised.

Importantly, the study identified women with PF and patients younger than 50 with pulmonary sarcoidosis to be at greatest risk of heart attack.

The study, “Interstitial lung disease is a risk factor for ischaemic heart disease and myocardial infarction,” was published in the journal Heart.

ILDs include several disorders characterized by fibrotic (scarring) and/or inflammatory changes in lung tissue. The most common type of ILD is idiopathic pulmonary fibrosis (PF).

Ischemic heart disease (IHD), also called coronary heart disease, is prevalent among patients with ILDs, and it is the second most common cause of death in IPF (after IPF itself).

Although the coexistence of IDLs and IHD and their shared risk factors are known, there is limited research about the risk of IHD in patients with IDLs.

So, researchers at Keele University in the United Kingdom investigated the risk of IHD and myocardial infarction (MI, commonly called a heart attack) in a large group of patients with ILD, selected from the Clinical Practice Research Datalink.

The study included 11,688 ILD patients (average age 62.2) — of which 4,568 had a diagnosis of pulmonary sarcoidosis, and 7,120 of PF — and 56,884 non-IDL matched controls.

Results showed that compared to PF and controls, patients with pulmonary sarcoidosis were younger, had a lower burden of cardiovascular risk factors, and a longer median follow-up.

The presence of ILD was associated with a 59% increased risk of IHD compared with controls.

Patients with PF, in particular, had a two- to three-times greater incidence of acute MI and IHD in younger age groups, compared with pulmonary sarcoidosis and controls.

Both men and women with ILD were at increased risk for IHD and MI, slightly higher in men, compared to controls, the researchers found.

Moreover, women with PF had the greatest risk of MI (approximately 80% increased risk), while men with PF had the greatest risk for IHD (also 80% greater risk). In contrast, women with pulmonary sarcoidosis were not at increased risk of IHD or MI.

The risk of heart events (both IHD and MI) was higher in those between the ages of 60–69, except for MI in pulmonary sarcoidosis, which was highest in the youngest age group (younger than 50).

Based on those results, the team concluded that “the presence of PF provides independent information to the incident risk of MI/IHD on top of classical cardiovascular [risk factors].”

“Our results enable clinicians to identify which cohorts of ILD patients are most at risk of IHD and MI, and target their assessment of cardiovascular risk appropriately,” the researchers wrote.

Furthermore, the team suggested that “clinicians should [prioritize] targeted assessment of cardiovascular risk in patients with ILD, particularly those aged 60–69 years,” and that “further research is needed to understand the impact of such an approach to risk management.”