Use of coronary artery calcium testing to improve coronary heart disease risk assessment in a lung cancer screening population

The Multi-Ethnic Study of Atherosclerosis (MESA)

Parveen K. Garg, Neal W. Jorgensen, Robyn L. McClelland, J. Adam Leigh, Philip Greenland, Michael Blaha, Andrew J. Yoon, Nathan D. Wong, Joseph Yeboah, Matthew J. Budoff

Research output: Contribution to journalArticle

Abstract

Background: Assessment of coronary artery calcium (CAC) during lung cancer screening chest computed tomography (CT) represents an opportunity to identify asymptomatic individuals at increased coronary heart disease (CHD) risk. We determined the improvement in CHD risk prediction associated with the addition of CAC testing in a population recommended for lung cancer screening. Methods: We included 484 out of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants without baseline cardiovascular disease who met U.S. Preventive Service Task Force CT lung cancer screening criteria and underwent gated CAC testing. 10 year-predicted CHD risks with and without CAC were calculated using a validated MESA-based risk model and categorized into low (<5%), intermediate (5%–10%), and high (≥10%). The net reclassification improvement (NRI) and change in Harrell's C-statistic by adding CAC to the risk model were subsequently determined. Results: Of 484 included participants (mean age = 65; 39% women; 32% black), 72 (15%) experienced CHD events over the course of follow-up (median = 12.5 years). Adding CAC to the MESA CHD risk model resulted in 17% more participants classified into the highest or lowest risk categories and a NRI of 0.26 (p = 0.001). The C-statistic improved from 0.538 to 0.611 (p = 0.01). Conclusions: CHD event rates were high in this lung cancer screening eligible population. These individuals represent a high-risk population who merit consideration for CHD prevention measures regardless of CAC score. Although overall discrimination remained poor with inclusion of CAC scores, determining whether those reclassified to an even higher risk would benefit from more aggressive preventive measures may be important.

Original languageEnglish (US)
JournalJournal of Cardiovascular Computed Tomography
DOIs
StateAccepted/In press - Jan 1 2018

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Early Detection of Cancer
Coronary Disease
Lung Neoplasms
Atherosclerosis
Coronary Vessels
Calcium
Population
Tomography
Advisory Committees
Cardiovascular Diseases
Thorax

Keywords

  • Coronary artery calcium
  • Coronary heart disease
  • Lung cancer screening
  • Risk prediction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Use of coronary artery calcium testing to improve coronary heart disease risk assessment in a lung cancer screening population : The Multi-Ethnic Study of Atherosclerosis (MESA). / Garg, Parveen K.; Jorgensen, Neal W.; McClelland, Robyn L.; Leigh, J. Adam; Greenland, Philip; Blaha, Michael; Yoon, Andrew J.; Wong, Nathan D.; Yeboah, Joseph; Budoff, Matthew J.

In: Journal of Cardiovascular Computed Tomography, 01.01.2018.

Research output: Contribution to journalArticle

Garg, Parveen K. ; Jorgensen, Neal W. ; McClelland, Robyn L. ; Leigh, J. Adam ; Greenland, Philip ; Blaha, Michael ; Yoon, Andrew J. ; Wong, Nathan D. ; Yeboah, Joseph ; Budoff, Matthew J. / Use of coronary artery calcium testing to improve coronary heart disease risk assessment in a lung cancer screening population : The Multi-Ethnic Study of Atherosclerosis (MESA). In: Journal of Cardiovascular Computed Tomography. 2018.
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abstract = "Background: Assessment of coronary artery calcium (CAC) during lung cancer screening chest computed tomography (CT) represents an opportunity to identify asymptomatic individuals at increased coronary heart disease (CHD) risk. We determined the improvement in CHD risk prediction associated with the addition of CAC testing in a population recommended for lung cancer screening. Methods: We included 484 out of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants without baseline cardiovascular disease who met U.S. Preventive Service Task Force CT lung cancer screening criteria and underwent gated CAC testing. 10 year-predicted CHD risks with and without CAC were calculated using a validated MESA-based risk model and categorized into low (<5{\%}), intermediate (5{\%}–10{\%}), and high (≥10{\%}). The net reclassification improvement (NRI) and change in Harrell's C-statistic by adding CAC to the risk model were subsequently determined. Results: Of 484 included participants (mean age = 65; 39{\%} women; 32{\%} black), 72 (15{\%}) experienced CHD events over the course of follow-up (median = 12.5 years). Adding CAC to the MESA CHD risk model resulted in 17{\%} more participants classified into the highest or lowest risk categories and a NRI of 0.26 (p = 0.001). The C-statistic improved from 0.538 to 0.611 (p = 0.01). Conclusions: CHD event rates were high in this lung cancer screening eligible population. These individuals represent a high-risk population who merit consideration for CHD prevention measures regardless of CAC score. Although overall discrimination remained poor with inclusion of CAC scores, determining whether those reclassified to an even higher risk would benefit from more aggressive preventive measures may be important.",
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T1 - Use of coronary artery calcium testing to improve coronary heart disease risk assessment in a lung cancer screening population

T2 - The Multi-Ethnic Study of Atherosclerosis (MESA)

AU - Garg, Parveen K.

AU - Jorgensen, Neal W.

AU - McClelland, Robyn L.

AU - Leigh, J. Adam

AU - Greenland, Philip

AU - Blaha, Michael

AU - Yoon, Andrew J.

AU - Wong, Nathan D.

AU - Yeboah, Joseph

AU - Budoff, Matthew J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Assessment of coronary artery calcium (CAC) during lung cancer screening chest computed tomography (CT) represents an opportunity to identify asymptomatic individuals at increased coronary heart disease (CHD) risk. We determined the improvement in CHD risk prediction associated with the addition of CAC testing in a population recommended for lung cancer screening. Methods: We included 484 out of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants without baseline cardiovascular disease who met U.S. Preventive Service Task Force CT lung cancer screening criteria and underwent gated CAC testing. 10 year-predicted CHD risks with and without CAC were calculated using a validated MESA-based risk model and categorized into low (<5%), intermediate (5%–10%), and high (≥10%). The net reclassification improvement (NRI) and change in Harrell's C-statistic by adding CAC to the risk model were subsequently determined. Results: Of 484 included participants (mean age = 65; 39% women; 32% black), 72 (15%) experienced CHD events over the course of follow-up (median = 12.5 years). Adding CAC to the MESA CHD risk model resulted in 17% more participants classified into the highest or lowest risk categories and a NRI of 0.26 (p = 0.001). The C-statistic improved from 0.538 to 0.611 (p = 0.01). Conclusions: CHD event rates were high in this lung cancer screening eligible population. These individuals represent a high-risk population who merit consideration for CHD prevention measures regardless of CAC score. Although overall discrimination remained poor with inclusion of CAC scores, determining whether those reclassified to an even higher risk would benefit from more aggressive preventive measures may be important.

AB - Background: Assessment of coronary artery calcium (CAC) during lung cancer screening chest computed tomography (CT) represents an opportunity to identify asymptomatic individuals at increased coronary heart disease (CHD) risk. We determined the improvement in CHD risk prediction associated with the addition of CAC testing in a population recommended for lung cancer screening. Methods: We included 484 out of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants without baseline cardiovascular disease who met U.S. Preventive Service Task Force CT lung cancer screening criteria and underwent gated CAC testing. 10 year-predicted CHD risks with and without CAC were calculated using a validated MESA-based risk model and categorized into low (<5%), intermediate (5%–10%), and high (≥10%). The net reclassification improvement (NRI) and change in Harrell's C-statistic by adding CAC to the risk model were subsequently determined. Results: Of 484 included participants (mean age = 65; 39% women; 32% black), 72 (15%) experienced CHD events over the course of follow-up (median = 12.5 years). Adding CAC to the MESA CHD risk model resulted in 17% more participants classified into the highest or lowest risk categories and a NRI of 0.26 (p = 0.001). The C-statistic improved from 0.538 to 0.611 (p = 0.01). Conclusions: CHD event rates were high in this lung cancer screening eligible population. These individuals represent a high-risk population who merit consideration for CHD prevention measures regardless of CAC score. Although overall discrimination remained poor with inclusion of CAC scores, determining whether those reclassified to an even higher risk would benefit from more aggressive preventive measures may be important.

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KW - Risk prediction

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