Cardiovascular Events and Mortality in Interstitial Lung Disease with and Without Chronic Respiratory Failure: Risk and Timing

Background/Objective. Interstitial lung diseases (ILD) may be associated with chronic respiratory failure (CRF) and/or cardiovascular diseases (CVD) such as Pulmonary Hypertension, Ischemic Heart Diseases, Heart Failure, and Atrial Arrhythmias. Our research questions were: Does early CRF affect the mortality risk, and timing of the above CVD? Do CVD influence mortality in people with ILD? Methods. We conducted a seven-year, retrospective, observational, multicentre study comparing participants with ILD and early CRF (Cohort 1) and those with ILD alone (Cohort 2) (2392 participants in each cohort). We also assessed the effect of early CVD on mortality risk. Results. The cumulative incidence of death was 65.84% and 38.27% (p < 0.01), while that of any CVD was 79.31% and 46.19% (p < 0.01) for Cohorts 1 and 2, respectively. The time to and cumulative incidence of each of the above CVD were higher in Cohort 1 than in Cohort 2 (all p < 0.001). Incident cardiovascular events were associated with a higher and earlier risk of death in people without but not in those with ILD and early CRF, indicating that CRF plays a role in mortality rates, regardless of those of CVD. Conclusions. Our study suggests an association between chronic respiratory failure, cardiovascular events, and mortality, although it cannot prove causality. These findings indicate the need for structured lung function assessment and closer cardiovascular surveillance in people with ILD, particularly in those developing chronic respiratory failure.