Parveen K Garg1, Neal W Jorgensen2, Robyn L McClelland3, J Adam Leigh4, Philip Greenland5, Michael J Blaha6, Andrew J Yoon7, Nathan D Wong8, Joseph Yeboah9, Matthew J Budoff10. 1. Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, United States. Electronic address: parveeng@med.usc.edu. 2. Department of Biostatistics, University of Washington, Seattle, WA, United States. Electronic address: njorgens@u.washington.edu. 3. Department of Biostatistics, University of Washington, Seattle, WA, United States. Electronic address: rmcclell@u.washington.edu. 4. Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, United States. Electronic address: j.adam.leigh@gmail.com. 5. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. Electronic address: p-greenland@northwestern.edu. 6. Divisions of Cardiology and Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, United States. Electronic address: mblaha1@jhmi.edu. 7. Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, United States. Electronic address: AYoon@memorialcare.org. 8. Heart Disease Prevention Program, Division of Cardiology, University of California at Irvine, Irvine, CA, United States. Electronic address: ndwong@uci.edu. 9. Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, United States. Electronic address: jyeboah@wakehealth.edu. 10. Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, United States. Electronic address: mbudoff@labiomed.org.
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.
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 MESACHD 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.
Authors: Michael E Layoun; Eric H Yang; Joerg Herrmann; Cezar A Iliescu; Juan C Lopez-Mattei; Kostas Marmagkiolis; Matthew J Budoff; Maros Ferencik Journal: Curr Treat Options Oncol Date: 2019-05-06
Authors: Tina D Tailor; Caroline Chiles; Joseph Yeboah; M Patricia Rivera; Betty C Tong; Fides R Schwartz; Thad Benefield; Lindsay M Lane; Ilona Stashko; Samantha M Thomas; Louise M Henderson Journal: J Am Coll Radiol Date: 2021-02-26 Impact factor: 6.240
Authors: Frances M Wang; Cara Reiter-Brennan; Zeina Dardari; Catherine H Marshall; Khurram Nasir; Michael D Miedema; Daniel S Berman; Alan Rozanski; John A Rumberger; Matthew J Budoff; Omar Dzaye; Michael J Blaha Journal: Am J Prev Cardiol Date: 2020-11-12