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Evaluation of cardiovascular risk in a lung cancer screening cohort
  1. Mamta Ruparel1,
  2. Samantha L Quaife2,
  3. Jennifer L Dickson1,
  4. Carolyn Horst1,
  5. Stephen Burke3,
  6. Magali Taylor4,
  7. Asia Ahmed4,
  8. Penny Shaw4,
  9. May-Jan Soo3,
  10. Arjun Nair4,
  11. Anand Devaraj5,
  12. Emma Louise O'Dowd6,
  13. Angshu Bhowmik7,
  14. Neal Navani1,8,
  15. Karen Sennett9,
  16. Stephen W Duffy10,
  17. David R Baldwin6,
  18. Reecha Sofat11,
  19. Riyaz S Patel11,
  20. Aroon Hingorani11,
  21. Sam M Janes1
  1. 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
  2. 2 Research Department of Behavioural Science and Health, University College London, London, UK
  3. 3 Department of Radiology, Homerton University Hospital NHS Foundation Trust, London, UK
  4. 4 Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
  5. 5 Department of Radiology, Royal Brompton Hospital, London, UK
  6. 6 Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
  7. 7 Respiratory Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
  8. 8 Thoracic Department, University College London Hospitals NHS Foundation Trust, London, UK
  9. 9 Killick Street Health Centre, London, UK
  10. 10 Wolfson Institute of Preventive Medicine, Barts and London, London, UK
  11. 11 Institute of Cardiovascular Science, University College London, London, UK
  1. Correspondence to Dr Sam M Janes, Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; s.janes{at}ucl.ac.uk

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.

  • Lung Cancer

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Footnotes

  • Contributors MR, SLQ, JLD, MT, AA, PS, SB, M-JS, AN, AD, AB, NN, DRB, SWD and SMJ all contributed to the design and/or of the conduct study. AN, CH, EOD, RSP, RS and AH made a significant intellectual contribution with interpretation of the data from the study. All authors contributed to the preparation and approved the final version of the manuscript.

  • Funding This study was part of the Lung Screen Uptake Trial, which was funded by a National Awareness and Early Diagnosis Initiative (NAEDI) project grant awarded by Cancer Research UK (CRUK) and a consortium of funders (Department of Health (England); Economic and Social Research Council; Health and Social Care R&D Division, Public Health Agency, Northern Ireland; National Institute for Social Care and Health Research, Wales; Scottish Government) (SLQ and SMJ). MR, SLQ and SMJ have received funding from the Roy Castle Lung Cancer Foundation. SMJ is a Wellcome Trust Senior Fellow in Clinical Science (WT107963AIA). SMJ is supported by the Rosetrees Trust, the Stoneygate Trust, the Welton Trust, the Garfield Weston Trust and UCLH Charitable Foundation. This work was undertaken at UCLH/UCL who received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centre’s funding scheme (NN, SMJ). SLQ is supported by a Cancer Research UK Postdoctoral Fellowship ((C50664/A24460). AN receives a proportion of funding from the Department of Health NIHR Biomedical Research Centres Funding Scheme at University College London Hospitals (UCLH)/University College London (UCL).

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval This study is part of the Lung Screen Uptake Trial (LSUT), which was granted ethical approval by the City Road and Hampstead NHS Research Ethics Committee (REC; reference: 15/LO/1186) and was registered with clinicaltrials.gov (NCT02558101) and the International Standard Registered Clinical/soCial sTudy Number (ISRCTN21774741).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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