A new study from UCLA and the University of Pennsylvaniashows that patients with pulmonary fibrosis, a progressive lung disease, aremore likely also to develop heart disease. The study may lead to a greaterunderstanding of both diseases and the role of inflammation, as well as helpdevelop new treatments.
Published in the March 8 issue of the Archives of InternalMedicine, the study showed that patients with pulmonary fibrosis were fourtimes more likely to have extensive coronary artery disease compared withpatients without this type of lung condition.
"We were very surprised by the large number of pulmonaryfibrosis patients who had also developed advanced coronary artery disease,"said Dr. David A. Zisman, senior author and director of the Interstitial LungDisease Program and assistant professor of the Division of Pulmonary andCritical Care Medicine at the David Geffen School of Medicine at UCLA.
This is the first study of its kind, and researchers notethat pulmonary fibrosis and coronary artery disease may prove very similar —both cause inflammation that leads to scarring and/or plaque development."Visually the disease processes look very much the same," Zisman said.
According to Zisman, this study adds to the growing body ofresearch taking a closer look at the impact of the inflammation processthroughout the body. "Inflammation plays a key role in so many diseases, fromAlzheimer's disease and heart disease to cancers as well as pulmonaryfibrosis," Zisman said. "The more we learn about the interaction of suchdiseases, the better we will be able to direct treatments."
"In the next step of research, we will look more closely atthe processes that underlie development of these two diseases," said Dr. RobertM. Strieter, a study author, chief of the Division of Pulmonary and CriticalCare Medicine, and vice chair of medicine at the David Geffen School ofMedicine at UCLA. He adds that the disease process generating pulmonaryfibrosis in the lungs may have more systemic effects — causing similarinflammation processes in other areas of the body, such as development ofcoronary artery disease.
According to Strieter, researchers will next try to identifywhich substances a pulmonary fibrosis lung makes that may reach the heart toproduce or exacerbate heart disease.
Study investigators reviewed coronary angiograms of 630patients at the University of Pennsylvania, who were being evaluated for lungtransplant. Although patients had a wide range of lung disorders, those withpulmonary fibrosis had twice the risk of having coronary artery disease andfour times the risk of having more extensive coronary artery disease thanpatients without this condition.
The most common form of pulmonary fibrosis is idiopathicpulmonary fibrosis that affects 5 million worldwide and 100,000 in the UnitedStates. The progressive disease causes inflammation and scarring of the lungsand most patients are eventually referred for lung transplant.
Heart disease or coronary artery disease — the No. 1 killerin the United States — causes blockages of the arteries that feed the heartmuscle, which could lead to a heart attack.
The study was funded by the National Institutes of Healthand a private donation.
Additional study authors include Dr. Jorge R. Kizer,Division of Cardiology, Departments of Medicine and Public Health, WeillMedical College of Cornell University, New York City; Nancy P. Blumenthal, Dr.Robert M. Kotloff and Dr. John Hansen-Flaschen, Pulmonary, Allergy and CriticalCare Division, University of Pennsylvania School of Medicine, Philadelphia; Dr.Stephen E. Kimmel; Dr. Victor A. Ferrari, Cardiovascular Division of theDepartment of Medicine and the Department of Epidemiology and Biostatistics,Center for Clinical Epidemiology and Biostatistics, University of PennsylvaniaSchool of Medicine, Philadelphia; and Dr. Selim M. Arcasoy, Division ofPulmonary, Allergy and Critical Care, Department of Medicine, ColumbiaUniversity College of Physicians and Surgeons, New York City.