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Interstitial lung disease is a risk factor for ischaemic heart disease and myocardial infarction.

Mallen, C; Belcher, J; Mamas, M; Clarson, L; Welsh, V; Bajpai, R

Interstitial lung disease is a risk factor for ischaemic heart disease and myocardial infarction. Thumbnail


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Abstract

OBJECTIVES: Despite many shared risk factors and pathophysiological pathways, the risk of ischaemic heart disease (IHD) and myocardial infarction (MI) in interstitial lung disease (ILD) remains poorly understood. This lack of data could be preventing patients who may benefit from screening for these cardiovascular diseases from receiving it. METHODS: A population-based cohort study used electronic patient records from the Clinical Practice Research Datalink and linked Hospital Episode Statistics to identify 68?572 patients (11?688 ILD exposed (mean follow-up: 3.8 years); 56?884 unexposed controls (mean follow-up: 4.0 years), with 349?067 person-years of follow-up. ILD-exposed patients (pulmonary sarcoidosis (PS) or idiopathic pulmonary fibrosis (PF)) were matched (by age, sex, registered general practice and available follow-up time) to patients without ILD or IHD/MI. Rates of incident MI and IHD were estimated. HRs were modelled using multivariable Cox proportional hazards regression accounting for potential confounders. RESULTS: ILD was independently associated with IHD (HR 1.85, 95% CI 1.56 to 2.18) and MI (HR 1.74, 95%?CI 1.44 to 2.11). In all disease categories, risk of both IHD and MI peaked between ages 60 and 69 years, except for the risk of MI in PS which was greatest <50 years. Men with PF were at greatest risk of IHD, while women with PF were at greatest risk of MI. CONCLUSIONS: ILD, particularly PF, is independently associated with MI and IHD after adjustment for established cardiovascular risk factors. Our results suggest clinicians should prioritise targeted assessment of cardiovascular risk in patients with ILD, particularly those aged 60-69?years. Further research is needed to understand the impact of such an approach to risk management.

Acceptance Date Dec 9, 2019
Publication Date May 27, 2020
Publicly Available Date Mar 28, 2024
Journal Heart
Print ISSN 1355-6037
Publisher BMJ Publishing Group
Pages 916-922
DOI https://doi.org/10.1136/heartjnl-2019-315511
Keywords Lung disease, risk factor, heart disease, myocardial infarction
Publisher URL http://dx.doi.org/10.1136/heartjnl-2019-315511

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