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Association Between Pulmonary Fibrosis and Coronary Artery Disease
Jorge R. Kizer, MD, MSc;
David A. Zisman, MD;
Nancy P. Blumenthal, MSN, CRNP;
Robert M. Kotloff, MD;
Stephen E. Kimmel, MD, MS;
Robert M. Strieter, MD;
Selim M. Arcasoy, MD;
Victor A. Ferrari, MD;
John Hansen-Flaschen, MD
Arch Intern Med. 2004;164:551-556.
Background Pulmonary fibrosis and atherosclerosis have many similarities at the histopathologic level. Moreover, fibrotic lung diseases exhibit systemic effects and have the potential to affect the vasculature beyond the lung. The existence of a relationship between the two, however, has not been studied.
Methods To investigate whether fibrotic lung disorders may predispose to atherosclerosis, we conducted a cross-sectional study of 630 patients referred for lung transplantation evaluation at a university hospital. We compared the prevalence of angiographic coronary artery disease (CAD) in patients with fibrotic vs nonfibrotic lung diseases.
Results Fibrotic lung diseases were associated with an increased prevalence of CAD compared with nonfibrotic diseases after adjustment for traditional risk factors (odds ratio, 2.18; 95% confidence interval, 1.17-4.06). The magnitude and significance of this association were maintained when only nongranulomatous fibrotic disease or its subset, idiopathic pulmonary fibrosis, was examined. The strength of the relationship between fibrotic disorders and CAD increased when multivessel disease was analyzed (odds ratio, 4.16; 95% confidence interval, 1.46-11.9). No significant association was detected for granulomatous fibrotic disorders (odds ratio, 1.56; 95% confidence interval, 0.47-5.16; P = .47), although this subgroup had fewer cases of CAD for analysis.
Conclusions These findings support an association between fibrotic lung disorders and CAD. Further research is necessary to confirm this relationship and to explore the pathologic processes underlying, and potentially linking, these 2 conditions.
From the Division of Cardiology, Departments of Medicine and Public Health, Weill Medical College of Cornell University, New York, NY (Dr Kizer); the Pulmonary, Allergy, and Critical Care Division (Drs Zisman, Kotloff, and Hansen-Flaschen and Ms Blumenthal), the Cardiovascular Division, Department of Medicine (Drs Kimmel and Ferrari), and the Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics (Dr Kimmel), University of Pennsylvania School of Medicine, Philadelphia; the Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif (Dr Strieter); and the Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University College of Physicians and Surgeons, New York (Dr Arcasoy). Dr Zisman is now with the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA.
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