S67 Association of airflow obstruction identified at lung cancer screening with major adverse cardiovascular events

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Introduction Lung cancer and cardiovascular disease are leading causes of death in individuals with COPD. Lung cancer screening (LCS) reduces lung cancer related mortality and offers an opportunity to identify those with undiagnosed airflow obstruction. However, there is limited evidence linking airflow obstruction with cardiovascular morbidity and mortality in LCS cohorts. Methods Quality-assured handheld pre-bronchodilator spirometry was performed during baseline SUMMIT study (NCT03934866) LCS appointments. The best of three forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) values were recorded, with airflow obstruction defined as an FEV1/FVC ratio of <0.7. GOLD criteria were used to categorise airflow obstruction severity. Baseline airways disease was either self-reported or obtained from primary care records. Hospital Episode Statistics and National Cancer Registration and Analysis Service data identified MACE (acute myocardial infarction, stroke, cardiovascular death, unstable angina and heart failure). Kaplan-Meier and Cox regression analyses were used to quantify the association between airflow obstruction and MACE. Covariates included age, sex, smoking status, smoking history, BMI, coronary artery calcification and baseline cardiovascular disease. Results 11,025 participants underwent spirometry. Median age was 65 (IQR 60–70 years). 58% (n=6337/11025) were men, 49% (n=5346/11025) current smokers and 31% (n=3414/11025) had baseline airways disease. 49% (n=5449/11025) had obstructive spirometry at LCS, 58% of whom (n=3148/5449) had no baseline airways disease. 5% (n=552/11,025) of participants had at least one MACE over a median follow-up of 5.0 years (IQR 4.8–5.2). Kaplan-Meier analyses demonstrated that regardless of baseline airways disease, airflow obstruction was associated with worse MACE-free survival compared to no airflow obstruction (figure 1a) and increasing severity of airflow obstruction was associated with worse cardiovascular outcomes (figure 1b). In multivariable Cox regression analysis, airflow obstruction was independently associated with an increased risk of MACE (aHR 1.22 (95%CI 1.02–1.45)) compared to no airflow obstruction. Discussion Airflow obstruction is common in LCS populations and associated with an increased risk of MACE. LCS provides an enriched population at high risk of poor cardiovascular outcomes due to overlapping risk factors. Identifying airflow obstruction in this population may offer an opportunity to more comprehensively assess cardiovascular risk, enabling implementation of targeted prevention strategies.

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