Evaluation of cardiovascular risk in a lung cancer screening cohort

Abstract

Introduction: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: ClinicalTrials.gov NCT02558101.

Keywords: Lung Cancer.

Conflict of interest statement

Competing interests: SMJ, MR, JLD and CH are supported by funding for a large trial of low dose CT screening, called the ‘SUMMIT Study’ by GRAIL Inc. SQ collaborates on the SUMMIT study. SMJ has received honoraria from Astra Zeneca, BARD1 Bioscience and Achilles Therapeutics for being an Advisory Board Expert and travel to a US conference. SMJ receives grant funding from Owlstone for a separate research study and has a family member with a financial association with Astra Zeneca. MR has received travel funding for a conference from Takeda and an honorarium for speaking at educational meeting from Astra Zeneca. AN is a member of the Advisory Board for Aidence Artificial Intelligence. RS has received honoraria, consulting and speaker fees from Amgen, Sanofi and Bayer. SMJ, MR, JLD, CH, SQ, AN and RS perceive that these disclosures pose no academic conflict for this study. All other authors have no other competing interests to declare.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1

Flow diagram for study participants. CHD, coronary heart disease; LCS, lung cancer screening; LDCT, low-dose computed tomography; LHC, lung health check; LSUT, Lung Screen Uptake Trial.

Figure 2

Examples of participants with mild (A,B), moderate (C,D) and heavy (E,F) coronary artery calcification.

Figure 3

QRISK2 score distribution for each visually determined CAC grade on LDCT. The boxes contain the 25th to 75th QRISK2 scores within each category, with the median value represented by a solid line running through the box. The whiskers extend to the upper and lower adjacent values and the dots represent the outliers. An extra horizontal dotted line has been added to demonstrate the threshold for initiation of statin therapy for primary prevention in the UK (10%). Posthoc p values corrected for multiple comparisons between group medians are highlighted. CAC, coronary artery calcification; LDCT, low-dose computed tomography.