Patients with idiopathic pulmonary fibrosis may face a substantially higher risk of cardiovascular disease, according to a systematic review and meta-analysis of 28 studies conducted across 10 countries.
The pooled results showed that patients with idiopathic pulmonary fibrosis (IPF) were more than twice as likely to develop cardiovascular disease compared with patients without IPF. Case-control and cross-sectional studies reported an overall odds ratio of 2.44, while cohort studies showed a relative risk of 1.44.
Across specific conditions, ischemic heart disease carried an odds ratio of 2.34, coronary artery disease 2.51, acute ischemic heart disease 2.03, thromboembolic disease 2.12, pulmonary hypertension 1.88, arrhythmia 1.34, heart failure 1.37, and valvular heart disease 1.14. All reported associations were statistically significant.
“Chronic fibrosis represents a shared terminal pathway in both IPF and various [cardiovascular] diseases. Taken together, aging drives the coprogression of IPF and CV disease by establishing a profibrotic microenvironment,” said lead study author Yang Li, of the Graduate School at Beijing University of Chinese Medicine, and colleagues.
Investigators searched PubMed, Embase, Web of Science, the Cochrane Library, and Sinomed through April 2025. The review followed PRISMA guidelines and was prospectively registered with PROSPERO (CRD420251013917). Among the 4,989 records identified, 92 full-text articles were reviewed and 28 studies met inclusion criteria.
Data extracted included study design, country, diagnostic methods, sample size, and patient characteristics. Odds ratios and relative risks were calculated using fixed- or random-effects models. Heterogeneity was tested with I², and publication bias was evaluated with funnel plots and Egger’s test.
The investigators reported heterogeneity, particularly in cohort studies, partially driven by self-reported cardiovascular outcomes. Many of the included studies were retrospective, limiting causal inference. Some confounders, such as hypertension and dyslipidemia, weren't consistently adjusted across studies. Diagnostic criteria for IPF and cardiovascular endpoints varied, and only four prospective cohort data sets were available.
The findings showed that IPF increased the risk of cardiovascular disease across multiple categories. The associations remained after adjustments for smoking, diabetes, and body mass index. The investigators noted that cardiovascular complications added to the disease burden in patients with IPF, which primarily affects adults older than 60 years.
Full disclosures can be found in the published study.
Source: Frontiers in Medicine