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Updated: Jun 14, 2025
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Cardiovascular disease in connective tissue disease-associated interstitial lung disease: A systematic review and
Ziyi Hu1, Haolan Wang1, Jinyu Huang1
1Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong Hospital of Beijing Anzhen Hospital Capital Medical University, Nanchong, Sichuan, China.
Insights
Patients with connective tissue disease-associated interstitial lung disease (CTD-ILD) face a 1.65-fold higher risk of cardiovascular disease. This increased risk is linked to higher rates of heart failure, arrhythmia, and pulmonary hypertension, particularly in male smokers.
Area of Science:
- Rheumatology and Cardiology
- Pulmonology
- Systematic Reviews and Meta-Analyses
Background:
- Connective tissue diseases (CTD) can lead to interstitial lung diseases (ILD), increasing the complexity of patient care.
- Cardiovascular (CV) disease is a significant concern in the general population, but its prevalence in CTD-ILD requires specific investigation.
Approach:
- A systematic review and meta-analysis were conducted following PRISMA guidelines.
- Searched multiple databases (PubMed, Embase, Scopus, etc.) up to April 2024 for relevant studies.
- Included 13 studies with 12,520 patients to assess CV disease risk in CTD-ILD.
Key Points:
- CTD-ILD patients exhibit a 1.65-fold increased risk of CV disease compared to CTD patients without ILD.
- Higher prevalence of heart failure (RR=2.84) and arrhythmia (RR=1.55) observed in CTD-ILD.
- Risk factors include male sex and smoking; RA-ILD and SSc-ILD subtypes show increased CV risk.
Conclusions:
- CTD-ILD significantly elevates cardiovascular disease risk, manifesting as heart failure and arrhythmia.
- Rheumatoid arthritis-ILD (RA-ILD) and systemic sclerosis-ILD (SSc-ILD) are associated with higher CV risk.
- Pulmonary arterial hypertension is more prevalent in CTD-ILD patients, underscoring the need for comprehensive cardiovascular monitoring.
Objectives:
We performed a systematic review and meta-analysis to assess whether patients with connective tissue disease (CTD)-associated interstitial lung diseases (ILD) have an increased prevalence of cardiovascular (CV) disease and to validate associated risk factors.
Methods:
The PRISMA guidelines and PICO model were followed. We searched PubMed, Embase, Cochrane Library databases, Scopus, and Directory of Open Access Journals from inception to April 2024.
Results:
Thirteen studies comprising of 12,520 patients were included. Patients with CTD-ILD had a significantly increased risk of CV disease than patients with CTD (relative risk [RR] = 1.65, 95 % confidence interval [CI]: 1.41, 1.93), which are related to the proportion of men (P = 0.001) and the proportion of smokers (P = 0.045). Subgroup analysis found that patients with CTD-ILD had a higher risk of heart failure (RR = 2.84, 95 % CI: 1.50, 5.39), arrhythmia (RR = 1.55, 95 % CI: 1.22, 1.97) than patients with CTD. Another subgroup analysis showed that RA-ILD and SSc-ILD were associated with an increased risk of CV disease, but not IIM-ILD and MCTD-ILD (RA-ILD: RR = 2.19, 95 % CI: 1.27, 3.80; SSc-ILD: RR = 1.53, 95 % CI: 1.29, 1.82). Besides, patients with CTD-ILD had a higher prevalence of pulmonary arterial hypertension (RR = 2.48, 95 % CI: 1.69, 3.63) than patients with CTD.
Conclusions:
Patients with CTD-ILD had a 1.65 times increased risk of CV than patients with CTD-non-ILD, with increased prevalence of heart failure and arrhythmia. The risk of CV disease in SSc-ILD and RA-ILD is increased and we should pay more attention to male smokers. In addition, compared with CTD patients, CTD-ILD patients had a higher risk of pulmonary arterial hypertension.
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