Prevalence and impact of coronary artery disease in idiopathic pulmonary fibrosis.
BACKGROUND
Idiopathic Pulmonary Fibrosis (IPF) is a progressive disease with a poor prognosis for which there is no effective medical therapy. An awareness of comorbidities that are treatable and might impact outcomes in these patients is therefore very important. We sought to determine the prevalence of coronary artery disease (CAD) in IPF patients in comparison to a control group of patients with chronic obstructive pulmonary disease (COPD). We also sought to assess the impact of CAD on IPF patient outcomes.


METHODS
IPF and COPD transplant candidates whose work-up included left heart catheterization were categorized as having significant CAD, non-significant CAD or no disease. The risk factor profile and prevalence of CAD in both groups was compared.


RESULTS
There were 73 IPF and 56 COPD patients. The prevalence of CAD was 65.8% in the IPF group compared to 46.1% in the COPD patients (p<0.028). Significant disease was present in 28.8% of IPF patients vs.16.1% of the COPD patients (p<0.081). Unsuspected significant CAD was found in 18% of IPF patients versus 10.9% of COPD patients (p<0.004). Outcomes of IPF patients with significant CAD was worse than those with no or non-significant disease (p<0.003) with a median survival of 572 days from the time of left heart catheterization.


CONCLUSIONS
There is a higher prevalence of CAD in IPF patients compared to a similarly matched COPD group. This increased association appeared to be independent of common coronary artery risk factors. IPF patients with significant CAD appear to have worse outcomes.
Nathan
Steven D
SD
Inova Transplant Center, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA. steven.nathan@inova.org
Basavaraj
Ashwin
A
Reichner
Cristina
C
Shlobin
Oksana A
OA
Ahmad
Shahzad
S
Kiernan
Joseph
J
Burton
Nelson
N
Barnett
Scott D
SD
D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013147:Spirometry; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology