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Cardiac risk factors and prevention
Original research
Interstitial lung disease is a risk factor for ischaemic heart disease and myocardial infarction
  1. Lorna Elise Clarson1,
  2. Ram Bajpai1,
  3. Rebecca Whittle1,
  4. John Belcher1,
  5. Alyshah Abdul Sultan1,
  6. Chun Shing Kwok2,
  7. Victoria Welsh1,
  8. Mamas Mamas2,
  9. Christian D Mallen1
  1. 1 School of Primary, Community and Social Care, Keele University, Keele, UK
  2. 2 Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
  1. Correspondence to Dr Lorna Elise Clarson, Keele University, Newcastle ST5 5BG, UK; l.clarson{at}keele.ac.uk

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.

  • cardiac risk factors and prevention
  • coronary artery disease
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/heartjnl-2019-315511

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    Footnotes

    • Twitter @RamBajpai16, @DrShingKwok

    • Contributors All authors were involved in the inception and design of the study. LC, RB and JB were responsible for analysis of the data. All authors were involved in the interpretation of the data and the preparation of the manuscript.

    • Funding This work was supported by the National Institute for Health Research School for Primary Care Research Grant Number: 255. Clarson and Welsh are funded by NIHR Academic Clinical Lectureships. Mallen is funded by the NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice, which also supports Bajpai (NIHR-RP-2014-04-026). The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care. The funder was not involved in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the author/s alone. HES data Copyright © (2019), re-used with the permission of The Health & Social Care Information Centre. All rights reserved. The data used in this study can only be used for the purposes set out in the submitted and approved ISAC protocol. No data can, therefore, be archived by the research team. Any future research would require a new application to CPRD with data obtained directly from CPRD subject to their policies for scientific, data governance, and financial approvals (see www.cprd.com).