Background <p>Cardiovascular comorbidities are well described in idiopathic pulmonary fibrosis (IPF); however, data in progressive pulmonary fibrosis (PPF) and direct IPF–PPF comparisons remain limited. We aimed to compare cardiovascular disease patterns in IPF versus PPF and to identify independent predictors of major cardiovascular comorbidities.</p> Methods <p>In this retrospective single-center cohort, adults with fibrotic interstitial lung disease were classified as IPF or PPF according to current international guidelines. IPF was diagnosed based on multidisciplinary discussion incorporating clinical features, high-resolution computed tomography findings, and histopathological data when available, in accordance with ATS/ERS/JRS/ALAT recommendations. PPF was defined as disease progression in patients with non-IPF fibrosing interstitial lung disease despite appropriate management, based on worsening respiratory symptoms, decline in lung function, and/or radiological progression. Demographics, smoking exposure, pulmonary function parameters (FVC, DLCO), baseline laboratory parameters, and cardiovascular comorbidities [coronary artery disease (CAD), hypertension, atrial fibrillation/arrhythmia, congestive heart failure (HF), and pulmonary hypertension] were extracted from electronic medical records. Independent predictors of CAD, hypertension, and CHF were evaluated using hierarchical logistic regression models.</p> Results <p>Among 187 patients, 70 (37.4%) had PPF and 117 (62.6%) had IPF. IPF patients were older, more frequently male, and had higher cumulative smoking exposure than PPF patients. CAD (41.9% vs. 15.7%), hypertension (64.1% vs. 15.7%), and HF (29.9% vs. 14.3%) were more prevalent in IPF, whereas atrial fibrillation/arrhythmia and pulmonary hypertension did not differ significantly between groups. PPF patients had higher baseline DLCO, while baseline FVC was similar. Disease progression and mortality were more frequent in IPF. In hierarchical regression models, the crude association between IPF and CAD was attenuated after adjustment (OR 2.32, 95% CI 0.84–6.37), with former smoking remaining independently associated with CAD. IPF demonstrated a strong and independent association with hypertension across all models (OR 7.18, 95% CI 2.68–19.23). For HF, the crude association with IPF lost statistical significance after adjustment, while age remained an independent predictor (OR 1.07).</p> Conclusions <p>Patients with IPF exhibited a higher cardiovascular comorbidity burden than those with PPF, with hypertension emerging as the most consistent independent association. Differences in CAD and HF were largely explained by age and smoking-related factors after multivariable adjustment. These findings highlight the importance of systematic cardiovascular risk assessment and proactive management of modifiable risk factors, particularly blood pressure control, as part of comprehensive care for patients with IPF.</p>