Moderate-severe coronary calcification predicts long-term cardiovascular death in CT lung cancer screening: The ITALUNG trial

Coronary artery calcifications (CAC) are very strong indicators for increased cardio-vascular (CV) risk and can be evaluated also in low-dose computed tomography (LDCT) for lung cancer screening. We assessed whether a simple and fast CAC visual score is associated with CV mortality. CAC were retrosp...

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Published in:European journal of radiology 2021-12, Vol.145, p.110040-110040, Article 110040
Main Authors: Mascalchi, Mario, Puliti, Donella, Romei, Chiara, Picozzi, Giulia, De Liperi, Annalisa, Diciotti, Stefano, Bartolucci, Maurizio, Grazzini, Michela, Vannucchi, Letizia, Falaschi, Fabio, Pistelli, Francesco, Gorini, Giuseppe, Carozzi, Francesca, Rosselli, Alessandro, Carrozzi, Laura, Paci, Eugenio, Zappa, Marco
Format: Article
Language:English
Subjects:
Calcinosis
Coronary artery calcification
Coronary Artery Disease - diagnostic imaging
Coronary Vessels
Early Detection of Cancer
Humans
Low-dose computed tomography
Lung cancer
Lung Neoplasms - diagnostic imaging
Male
Retrospective Studies
Risk Factors
Screening
Tomography, X-Ray Computed
Vascular Calcification - diagnostic imaging
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Summary:Coronary artery calcifications (CAC) are very strong indicators for increased cardio-vascular (CV) risk and can be evaluated also in low-dose computed tomography (LDCT) for lung cancer screening. We assessed whether a simple and fast CAC visual score is associated with CV mortality. CAC were retrospectively assessed by two observers using a 4-score (absent, mild, moderate and severe) scale in baseline LDCT obtained in 1364 participants to the ITALUNG trial who had 55–69 years of age and a smoking history ≥20 pack–years. Correlations with CV risk factors at baseline and with CV mortality after 11 years of follow-up were investigated. CAC were absent in 470 (34.5%), mild in 433 (31.7%), moderate in 357 (26.2%) and severe in 104 (7.6%) subjects. CAC severity correlated (≤0.001) with age, male sex, pack-years, history of arterial hypertension or diabetes, obesity and treated hypercholesterolemia. Twenty-one CV deaths occurred. Moderate or severe CAC were significantly associated with higher CV mortality after adjustment for all other known risk factors (ARR = 2.72; 95 %CI:1.04–7.11). Notably, also in subjects with none or one only additional CV risk factor, the presence of moderate-severe CAC allowed to identify a subgroup of subjects with higher CV death risk (RR = 3.66; CI95%:1.06–12.6). Moderate or severe CAC visually assessed in LDCT examinations for lung cancer screening are independently associated with CV mortality.
ISSN:0720-048X
1872-7727
DOI:10.1016/j.ejrad.2021.110040