The prevalence of coronary artery disease in end-stage pulmonary disease: Is pulmonary fibrosis a risk factor?

Background: It has been suggested that coronary artery disease (CAD) is a common complicating condition in pulmonary fibrosis. Objective: To establish and compare the incidence of coronary artery disease in lung-transplantation candidates with emphysema and lung fibrosis. Method: All adult patients (age > 40 years old) with emphysema or lung fibrosis, candidates for lung transplantation between January 1997 and December 2003, were included. All patients underwent pretransplant coronary angiography. Results: A total of 100 patients were enrolled; 51 with emphysema and 49 with fibrosis. CAD (at least one 50% stenotic coronary artery) was diagnosed in fourteen of 49 (28.6%) patients with lung fibrosis as compared to five out of 51 (9.8%) with emphysema, [p = 0.019] despite the fact that 98% of patients with emphysema but only 31% of the patients with lung fibrosis were heavy smokers. The groups didn't significantly differ in any other cardiovascular risks. Conclusions: There is significantly more CAD in lung-transplantation candidates with lung fibrosis as compared to those with emphysema, despite the fact that smoking was much more prevalent in the emphysema patients. These results suggest that the inflammatory process in lung fibrosis may involve the coronary arteries as a part of a systemic inflammation rather than an idiopathic fibrotic disease confined to the lungs.