IN idiopathic pulmonary fibrosis, ACE inhibitor therapy correlated with reduced all-cause mortality in matched records unlike COPD.
ACE Inhibitor Use and Idiopathic Pulmonary Fibrosis Survival
Angiotensin converting enzyme inhibitors are widely prescribed for hypertension and cardiovascular risk reduction, and prior mechanistic work has suggested potential antifibrotic relevance in idiopathic pulmonary fibrosis. To evaluate whether this translates into real world outcomes, investigators examined mortality outcomes and ACE inhibitor use in a large cohort of patients with idiopathic pulmonary fibrosis, using matched COPD control participants as a comparator group.
Study Design and Matched Real-World Cohorts
This retrospective analysis used linked electronic health record and national outcomes data from the Clinical Practice Research Datalink GP Online Database, with Hospital Episode Statistics and death registration records. Patients were stratified by ACE inhibitor use, defined as at least three prescriptions within the five years preceding diagnosis. The idiopathic pulmonary fibrosis cohort was propensity score matched to COPD control participants by age, sex, and smoking history. Multivariable Cox regression models adjusted for key confounders including BMI, smoking status, indices of multiple deprivation, diabetes mellitus, chronic kidney disease, and cardiovascular comorbidities. Competing risk analysis was applied in the idiopathic pulmonary fibrosis cohort to account for cause specific mortality.
Reduced All-Cause Mortality in IPF, Not COPD
The study included 3,579 patients with idiopathic pulmonary fibrosis and matched COPD control participants, with a mean age of 74 years and 36% female. ACE inhibitor use was more common in idiopathic pulmonary fibrosis than COPD. After adjustment, ACE inhibitor use was associated with improved survival in idiopathic pulmonary fibrosis, with lower all-cause mortality compared with non-use. In contrast, no similar survival association was observed in COPD.
Clinical Implications
These findings suggest ACE inhibitor therapy may be associated with reduced all-cause mortality in idiopathic pulmonary fibrosis in routine care settings, independent of measured comorbidities. The authors noted that prospective trials are warranted to confirm whether ACE inhibitor therapy has a causal role in improving outcomes in idiopathic pulmonary fibrosis.
Reference: Ozaltin B et al. Mortality Outcomes and Angiotensin-Converting Enzyme Inhibitor Use in Patients With Idiopathic Pulmonary Fibrosis. CHEST. 2026;169(1):139-147.
