Donella Puliti1, Mario Mascalchi2, Francesca Maria Carozzi3, Laura Carrozzi4, Fabio Falaschi5, Eugenio Paci6, Andrea Lopes Pegna7, Ferruccio Aquilini8, Alessandro Barchielli9, Maurizio Bartolucci10, Michela Grazzini11, Giulia Picozzi12, Francesco Pistelli13, Alessandro Rosselli14, Marco Zappa15. 1. Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy. Electronic address: d.puliti@ispro.toscana.it. 2. Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Italy. Electronic address: m.mascalchi@dfc.unifi.it. 3. Regional Prevention Laboratory Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy. Electronic address: f.carozzi@ispro.toscana.it. 4. Cardiothoracic and Vascular Department, University Hospital of Pisa, Italy; Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Italy. Electronic address: laura.carrozzi@unipi.it. 5. Radiology Department, University Hospital of Pisa, Italy. Electronic address: f.falaschi@ao-pisa.toscana.it. 6. Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy. Electronic address: paci.eugenio@gmail.com. 7. Pneumonology Department, Careggi Hospital, Florence, Italy. Electronic address: a.lopespegna@gmail.com. 8. Cardiothoracic and Vascular Department, University Hospital of Pisa, Italy. Electronic address: f.aquilini@ao-pisa.toscana.it. 9. Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy. Electronic address: abarchielli@virgilio.it. 10. Radiology Department, Careggi Hospital, Florence, Italy. Electronic address: mauriziobartolucci1@gmail.com. 11. Pneumonology Department, Hospital of Pistoia, Italy. Electronic address: mgrazzini@yahoo.com. 12. Radiodiagnostic Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy. Electronic address: g.picozzi@ispro.toscana.it. 13. Cardiothoracic and Vascular Department, University Hospital of Pisa, Italy. Electronic address: f.pistelli@ao-pisa.toscana.it. 14. Tuscan Regional Health Agency, Florence, Italy. Electronic address: ale.rosselli1@gmail.com. 15. Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy. Electronic address: m.zappa@ispro.toscana.it.
Abstract
OBJECTIVES: In the ITALUNG lung cancer screening trial after 9.3 years of follow-up we observed an unexpected significant decrease of cardiovascular (CV) mortality in subjects invited for low-dose CT (LDCT) screening as compared to controls undergoing usual care. Herein we extended the mortality follow-up and analyzed the potential factors underlying such a decrease. MATERIALS AND METHODS: The following factors were assessed in screenes and controls: burden of CV disease at baseline, changes in smoking habits, use of CV drugs and frequency of planned vascular procedures after randomisation. Moreover, in the screenes we evaluated inclusion of presence of coronary artery calcification (CAC) in the LDCT report form that was transmitted to the participant and his/her General Practitioner. RESULTS: The 2-years extension of follow-up confirmed a significant decrease of CV mortality in the subjects of the active group compared to control subjects (15.6 vs 34.0 per 10,000; p = 0.001) that was not observed in the drops-out of the active group. None of the explaining factors we considered significantly differed between active and control group. However, the subjects of the active group with reported CAC experienced a not significantly lower CV mortality and showed a significantly higher use of CV drugs and frequency of planned vascular procedures than the control group. CONCLUSIONS:LDCT screening for lung cancer offers the opportunity for detection of CAC that is an important CV risk factor. Although the underlying mechanisms are not clear, our results suggest that the inclusion of information about CAC presence in the LDCT report may represent a candidate factor to explain the decreased CV mortality observed in screened subjects of the ITALUNG trial, possibly resulting in intervention for patient care to prevent CV deaths. Further studies investigating whether prospective reporting and rating of CAC have independent impact on such interventions and CV mortality are worthy.
RCT Entities:
OBJECTIVES: In the ITALUNG lung cancer screening trial after 9.3 years of follow-up we observed an unexpected significant decrease of cardiovascular (CV) mortality in subjects invited for low-dose CT (LDCT) screening as compared to controls undergoing usual care. Herein we extended the mortality follow-up and analyzed the potential factors underlying such a decrease. MATERIALS AND METHODS: The following factors were assessed in screenes and controls: burden of CV disease at baseline, changes in smoking habits, use of CV drugs and frequency of planned vascular procedures after randomisation. Moreover, in the screenes we evaluated inclusion of presence of coronary artery calcification (CAC) in the LDCT report form that was transmitted to the participant and his/her General Practitioner. RESULTS: The 2-years extension of follow-up confirmed a significant decrease of CV mortality in the subjects of the active group compared to control subjects (15.6 vs 34.0 per 10,000; p = 0.001) that was not observed in the drops-out of the active group. None of the explaining factors we considered significantly differed between active and control group. However, the subjects of the active group with reported CAC experienced a not significantly lower CV mortality and showed a significantly higher use of CV drugs and frequency of planned vascular procedures than the control group. CONCLUSIONS: LDCT screening for lung cancer offers the opportunity for detection of CAC that is an important CV risk factor. Although the underlying mechanisms are not clear, our results suggest that the inclusion of information about CAC presence in the LDCT report may represent a candidate factor to explain the decreased CV mortality observed in screened subjects of the ITALUNG trial, possibly resulting in intervention for patient care to prevent CV deaths. Further studies investigating whether prospective reporting and rating of CAC have independent impact on such interventions and CV mortality are worthy.
Authors: Asha Bonney; Reem Malouf; Corynne Marchal; David Manners; Kwun M Fong; Henry M Marshall; Louis B Irving; Renée Manser Journal: Cochrane Database Syst Rev Date: 2022-08-03
Authors: Jordan Chamberlin; Madison R Kocher; Jeffrey Waltz; Madalyn Snoddy; Natalie F C Stringer; Joseph Stephenson; Pooyan Sahbaee; Puneet Sharma; Saikiran Rapaka; U Joseph Schoepf; Andres F Abadia; Jonathan Sperl; Phillip Hoelzer; Megan Mercer; Nayana Somayaji; Gilberto Aquino; Jeremy R Burt Journal: BMC Med Date: 2021-03-04 Impact factor: 8.775