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Risk factors for cardiovascular disease in people with idiopathic pulmonary fibrosis: a population-based study
William Dalleywater1, Helen A Powell2, Richard B Hubbard2
1Division of Epidemiology and Public Health, University of Nottingham, Nottingham, England.
Insights
People with idiopathic pulmonary fibrosis (IPF) have higher rates of cardiovascular disease, particularly ischemic heart disease (IHD). This increased risk is not fully explained by common cardiovascular risk factors like hypertension and diabetes.
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- Idiopathic pulmonary fibrosis (IPF) is linked to increased cardiovascular (CV) disease risk.
- The underlying reasons for this association remain unclear.
Purpose of the Study:
- To compare CV risk factor prevalence in IPF patients versus the general population.
- To determine the incidence of ischemic heart disease (IHD) and stroke post-IPF diagnosis, adjusting for risk factors.
Main Methods:
- Utilized a UK primary care database for IPF cases and matched controls.
- Compared pre-diagnosis CV risk factors and CV medication prescriptions.
- Assessed post-diagnosis IHD and stroke incidence.
Main Results:
- IPF patients showed higher prevalence of hypertension and diabetes.
- The rate of first-time IHD events was more than double in IPF patients.
- Stroke incidence was only marginally higher; adjustments for risk factors did not significantly alter IHD or stroke rates.
Conclusions:
- While CV risk factors are more common in IPF patients, they do not fully explain the elevated IHD rates.
- Further research is needed to understand the mechanisms driving increased IHD in IPF.
Objective:
People with idiopathic pulmonary fibrosis (IPF) have been shown to be at an increased risk for cardiovascular (CV) disease, but reasons for this are unknown. The aim of this study was to compare the prevalence of common CV risk factors in people with IPF and the general population and establish the incidence of ischemic heart disease (IHD) and stroke after the diagnosis of IPF, controlling for these risk factors.
Methods:
We used data from a large, UK primary care database to identify incident cases of IPF and matched general-population control subjects. We compared the prevalence of risk factors for CV disease and prescription of CV medications in people with IPF (before diagnosis) with control subjects from the general population and assessed the incidence of IHD and stroke in people with IPF (after diagnosis) compared with control subjects.
Results:
We identified 3,211 cases of IPF and 12,307 control subjects. Patients with IPF were more likely to have a record of hypertension (OR, 1.31; 95% CI, 1.19-1.44), and diabetes (OR, 1.20; 95% CI, 1.07-1.34) compared with control subjects; they were also more likely to have been prescribed several CV drugs. The rate of first-time IHD events was more than twice as high in patients than control subjects (rate ratio, 2.32; 95% CI, 1.85-2.93; P < .001), but the incidence of stroke was only marginally higher (P = .09). Rate ratios for IHD and stroke were not altered substantially after adjusting for CV risk factors.
Conclusions:
Several CV 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.
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