Mortality Outcomes and Angiotensin-Converting Enzyme Inhibitor Use in Patients With Idiopathic Pulmonary Fibrosis

Area of Science:

• Pulmonary Medicine
• Cardiovascular Pharmacology
• Real-world Evidence Studies

Background:

• Angiotensin-converting enzyme inhibitors (ACEi) are established antihypertensives with cardioprotective benefits.
• Prior research suggests ACEi therapy may slow disease progression and reduce mortality in idiopathic pulmonary fibrosis (IPF).

Purpose of the Study:

• To investigate the association between ACEi use and all-cause mortality in a real-world IPF patient population.
• To determine if a similar association exists in patients with chronic obstructive pulmonary disease (COPD).

Main Methods:

• Retrospective analysis of electronic health records from the CPRD GOLD database (2019) linked with HES and ONS data.
• Propensity score matching was used to stratify IPF and COPD patients based on ACEi use (≥3 prescriptions in 5 years).
• Multivariable Cox regression and competing risk analyses were performed, adjusting for multiple covariates.

Main Results:

• The study included 3,579 patients (3,7% IPF, 30% COPD) with a mean age of 74.
• ACEi use was associated with significantly reduced all-cause mortality in IPF patients (HR = 0.89, p = 0.013).
• No significant association between ACEi use and mortality was observed in the matched COPD cohort (HR = 1.09, p = 0.234).

Conclusions:

• ACEi therapy demonstrates an independent association with reduced all-cause mortality in IPF patients.
• This survival benefit was not observed in COPD patients.
• Prospective clinical trials are recommended to validate these findings in IPF populations.