Evaluation of cardiovascular risk in a lung cancer screening cohort

• Published in: Thorax Vol. 74; no. 12; p. 1140
• Main Authors: Ruparel, Mamta, Quaife, Samantha L, Dickson, Jennifer L, Horst, Carolyn, Burke, Stephen, Taylor, Magali, Ahmed, Asia, Shaw, Penny, Soo, May-Jan, Nair, Arjun, Devaraj, Anand, O'Dowd, Emma Louise, Bhowmik, Angshu, Navani, Neal, Sennett, Karen, Duffy, Stephen W, Baldwin, David R, Sofat, Reecha, Patel, Riyaz S, Hingorani, Aroon, Janes, Sam M
• Format: Journal Article
• Language: English
• Published: England 01-12-2019
• Subjects: Aged; Cardiovascular Diseases - complications; Cardiovascular Diseases - prevention & control; Cohort Studies; Coronary Disease - complications; Coronary Disease - diagnostic imaging; Cross-Sectional Studies; Drug Utilization - statistics & numerical data; Early Detection of Cancer - methods; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Lung Neoplasms - complications; Lung Neoplasms - diagnostic imaging; Male; Mass Screening - methods; Middle Aged; Primary Prevention - methods; Prospective Studies; Radiation Dosage; Risk Assessment - methods; Tomography, X-Ray Computed - methods; Vascular Calcification - complications; Vascular Calcification - diagnostic imaging; Lung Cancer
• ISSN: 1468-3296
• DOI: 10.1136/thoraxjnl-2018-212812

Lung cancer screening (LCS) by low-dose computed tomography (LDCT) offers an opportunity to impact both lung cancer and coronary heart disease mortality through detection of coronary artery calcification (CAC). Here, we explore the value of CAC and cardiovascular disease (CVD) risk assessment in LCS participants in the Lung Screen Uptake Trial (LSUT).
In this cross-sectional study, current and ex-smokers aged 60-75 were invited to a 'lung health check'. Data collection included a CVD risk assessment enabling estimation of 10 year CVD risk using the QRISK2 score. Participants meeting the required lung cancer risk underwent an ungated, non-contrast LDCT. Descriptive data, bivariate associations and a multivariate analysis of predictors of statin use are presented.
Of 1005 individuals enrolled, 680 were included in the final analysis. 421 (61.9%) had CAC present and in 49 (7.2%), this was heavy. 668 (98%) of participants had a QRISK2≥10% and QRISK2 was positively associated with increasing CAC grade (OR 4.29 (CI 0.93 to 19.88) for QRISK2=10%-20% and 12.29 (CI 2.68 to 56.1) for QRISK2≥20% respectively). Of those who qualified for statin primary prevention (QRISK2≥10%), 56.8% did not report a history of statin use. In the multivariate analysis statin use was associated with age, body mass index and history of hypertension and diabetes.
LCS offers an important opportunity for instituting CVD risk assessment in all LCS participants irrespective of the presence of LDCT-detected CAC. Further studies are needed to determine whether CAC could enhance uptake and adherence to primary preventative strategies.