Cardiovascular and antacid treatment and mortality in oxygen-dependent pulmonary fibrosis: A population-based longitudinal study

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Background and objective:Severe idiopathic pulmonary fibrosis is associated with an increased risk of cardiovascular disease and gastro-oesophageal reflux, which may influence prognosis. We evaluated associations between cardiovascular and antacid medications, and mortality, in oxygen-dependent pulmonary fibrosis (PF) of unknown cause.Methods:Prospective population-based study of adults starting long-term oxygen therapy (LTOT) for PF in Sweden 2005–2009. PF of unknown cause was defined by excluding patients with known or probable secondary PF. Time-dependent associations between medications and all-cause mortality were analysed using extended Cox regression, adjusting for potential confounders including age, sex, vital capacity, blood gases, body mass index, performance status, comorbidity and concurrent medications.Results:Of 462 included patients, 329 (71%) died under observation. No patient was lost to follow-up. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) were associated with reduced adjusted mortality (HR 0.63; 0.47–0.85) and antiplatelet drugs with increased mortality (HR 1.49; 1.11–2.00), largely driven by higher mortality in women. There were no associations with mortality for antacid treatments,β-blockers, diuretics or statins.Conclusion:In oxygen-dependent PF, treatment with ACEI/ARB was associated with improved survival, antiplatelet drugs with decreased survival, whereas there was no association between antacid,β-blocker, diuretic or statin treatment and survival.SUMMARY AT A GLANCEThis is a longitudinal study of cardiovascular and antacid treatments and mortality in oxygen-dependent pulmonary fibrosis. Adjusting for potential confounders, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) were associated with reduced mortality, antiplatelet drugs with increased mortality, whereas no association was found for antacid treatments, β-blockers, diuretics or statins.

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