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Double threat: Deadly lung disease also linked to heart attacks
December 05, 2008Patients with idiopathic pulmonary fibrosis (IPF) are three times as likely to experience severe coronary events-including heart attacks-than people without the disease, according to a recent study that analyzed the risk of cardiovascular disease in nearly 1,000 patients with IPF and more than 3,500 matched controls.
"If you look at them over time, people with IPF have roughly a three-fold increased risk of acute coronary syndrome, which is a greater increase than you get from smoking," said Richard B. Hubbard, M.D., British Lung Foundation professor of epidemiology at the University of Nottingham and lead author of the study.
The study was published in the second issue for December of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.
Dr. Hubbard and colleagues analyzed data from the computerized records of the UK's Health Improvement Network for 920 patients with idiopathic pulmonary fibrosis and 3,593 control subjects without IPF for diagnoses of coronary events and disease incidence.
In addition to having a markedly increased risk of heart problems, patients with IPF were 23 percent more likely to have angina, had a 60 percent higher risk of stroke, and a three-fold increased risk of deep vein thrombosis, according to Dr. Hubbard.
Notably, those with IPF were more than twice as likely as control subjects to have been prescribed amiodarone, a medication used for irregular heartbeats that has also been implicated as a cause of fibrotic lung disease.
This research could have serious implications for the 60,000 people with IPF who currently live in the United States and the 21,000 people who receive this diagnosis for the first time each year. Median survival from the time of diagnosis is about three years, and there are currently no treatments that have been shown to increase survival.
Unfortunately, medical knowledge about IPF is limited. "We know that genetic factors play some role in IPF because it clusters in families in about 10 percent of cases- and in a similar number of people there is evidence that environmental factors, such as exposure to metal dust at work and cigarette smoking may have a role," said Dr. Hubbard. "[But] studies from the U.S.A. and the U.K. suggest that IPF is becoming more common, and the reasons for this are unclear."
"Future investigations are required to better understand the relationship between IPF and systemic vascular disease as well as the mechanisms shared by the two syndromes," wrote David Zisman, M.D., and Steven Kawut, M.D., in an editorial in the same issue of the journal. "[I]f a causal association were confirmed- the presence of IPF itself could constitute a sufficiently potent risk factor for coronary artery disease such that more aggressive goals in risk factor modification would be warranted."
Such a mysterious disease as IPF raises a host of questions, but the most pressing ones are about how to improve and extend the lives of its victims.
"People with IPF have got a very bad outlook, and we may need to focus on other aspects of their health. The current guidelines are focused on palliative care so that people get oxygen and their symptoms treated, but maybe patients should go on heart prevention treatments right away," Dr. Hubbard said. "Future strategies could include a trial of anti-coagulant therapy in IPF patients," he added.
John Heffner, M.D., past president of the ATS, commented that this study introduces a change in our thinking of IPF. "As with other chronic, progressive respiratory disorders, the lungs in IPF may be the bellwether of other more systemic pathogenic events. What is first expressed in the lung becomes manifest later in other organ systems. This perspective will both realign research efforts and also direct more comprehensive healthcare to patients diagnosed with early IPF."
American Thoracic Society
Dr. Hubbard and colleagues analyzed data from the computerized records of the UK's Health Improvement Network for 920 patients with idiopathic pulmonary fibrosis and 3,593 control subjects without IPF for diagnoses of coronary events and disease incidence.
In addition to having a markedly increased risk of heart problems, patients with IPF were 23 percent more likely to have angina, had a 60 percent higher risk of stroke, and a three-fold increased risk of deep vein thrombosis, according to Dr. Hubbard.
Notably, those with IPF were more than twice as likely as control subjects to have been prescribed amiodarone, a medication used for irregular heartbeats that has also been implicated as a cause of fibrotic lung disease.
This research could have serious implications for the 60,000 people with IPF who currently live in the United States and the 21,000 people who receive this diagnosis for the first time each year. Median survival from the time of diagnosis is about three years, and there are currently no treatments that have been shown to increase survival.
Unfortunately, medical knowledge about IPF is limited. "We know that genetic factors play some role in IPF because it clusters in families in about 10 percent of cases- and in a similar number of people there is evidence that environmental factors, such as exposure to metal dust at work and cigarette smoking may have a role," said Dr. Hubbard. "[But] studies from the U.S.A. and the U.K. suggest that IPF is becoming more common, and the reasons for this are unclear."
"Future investigations are required to better understand the relationship between IPF and systemic vascular disease as well as the mechanisms shared by the two syndromes," wrote David Zisman, M.D., and Steven Kawut, M.D., in an editorial in the same issue of the journal. "[I]f a causal association were confirmed- the presence of IPF itself could constitute a sufficiently potent risk factor for coronary artery disease such that more aggressive goals in risk factor modification would be warranted."
Such a mysterious disease as IPF raises a host of questions, but the most pressing ones are about how to improve and extend the lives of its victims.
"People with IPF have got a very bad outlook, and we may need to focus on other aspects of their health. The current guidelines are focused on palliative care so that people get oxygen and their symptoms treated, but maybe patients should go on heart prevention treatments right away," Dr. Hubbard said. "Future strategies could include a trial of anti-coagulant therapy in IPF patients," he added.
John Heffner, M.D., past president of the ATS, commented that this study introduces a change in our thinking of IPF. "As with other chronic, progressive respiratory disorders, the lungs in IPF may be the bellwether of other more systemic pathogenic events. What is first expressed in the lung becomes manifest later in other organ systems. This perspective will both realign research efforts and also direct more comprehensive healthcare to patients diagnosed with early IPF."
American Thoracic Society
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A common weed and human cancer cells could provide some very uncommon details about DNA structure and its relationship with telomeres and how they affect cellular aging and cancer, according to a team led by scientists from Texas A&M University and the University of Cincinnati (UC).
New data: Hospital imaging centers poised to pull back, hitting patients hardest in rural areas
Survivors and patients with cancers and heart disease, along with patient advocate organizations and physicians, today urged policymakers to enhance early diagnosis of deadly diseases by preserving access to advanced imaging, such as MRI and CT scans, in final health care reform legislation.
Pitt team first to profile genes in acutely ill idiopathic pulmonary fibrosis patients
The first findings from a one-of-a-kind, patient-driven effort to provide lung tissue for research might help doctors predict when patients with idiopathic pulmonary fibrosis (IPF) are becoming dangerously ill and also could point the way to interventions that could sustain them until life-saving transplants can be performed.
Protein may be strongest indicator of rare lung disease, study shows
Researchers at the University of Cincinnati (UC) have discovered a protein in the lungs that can help in determining progression of the rare lung disease Idiopathic Pulmonary Fibrosis (IPF).
Large clinical trial finds pirfenidone may help lung function in IPF patients
A large, well-controlled, multi-national clinical trial program has demonstrated the effectiveness and safety of what may become the first FDA-approved medicine for idiopathic pulmonary fibrosis, or IPF.
UT Southwestern researchers identify gene linked to inherited form of fatal lung disease
Researchers at UT Southwestern Medical Center have determined that a mutation in a gene known for its role in defending the lungs against invading pathogens is responsible for some inherited cases of a lethal lung disease affecting older adults. The same mutation may also be associated with lung cancer, the researchers said.
Note to people with scarred and stiffened lungs: Monitor your sleep before severe fatigue sets in
Family, friends and neighbors remember Lisa Sandler Spaeth as an active mother of two in Potomac, Md., with a lot on the go, juggling her son's baseball games and her daughter's horseback-riding lessons with numerous committee obligations, organizing women's activities at her local synagogue.
Biomarkers identified for idiopathic pulmonary fibrosis
The first evidence of a distinctive protein signature that could help to transform the diagnosis and improve the monitoring of the devastating lung disease idiopathic pulmonary fibrosis (IPF) is being reported by University of Pittsburgh School of Medicine researchers in this month's edition of PLoS Medicine, an open-access journal of the Public Library of Science.
UCSF marks a milestone with 500th transplant in heart and lung program
UCSF marked a milestone this week with the 500th procedure in its Thoracic Transplant Program, which specializes in transplantation of the heart and lung.
Rare Lung Disease Cells Indicate Higher Death Risk
Large numbers of certain cells in the lungs of patients diagnosed with idiopathic pulmonary fibrosis may increase their chance of death, UC researchers have discovered.
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