Risk of major cardiovascular events in adults with coronary artery calcification identified in lung cancer screening

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Introduction: Low-dose CT (LDCT) in lung cancer screening (LCS) allows concurrent assessment of coronary artery calcification (CAC). Reporting incidental CAC is controversial, partly due to uncertain risk associated with visually-reported calcification instead of Agatston scoring. We report major adverse cardiovascular event (MACE) risk in a prospective LCS study. Methods: Baseline LDCTs in the SUMMIT study ( NCT03934866 ) had CAC visually graded in three major coronary arteries by the radiologist (none=0, minimum/mild=1, moderate=2, severe=3) and aggregated to give overall severity (none=0, mild=1-3, moderate=4-6, severe=7-9). Data from primary and secondary care were used to identify baseline cardiovascular disease (CVD) and subsequent MACE (acute myocardial infarction, stroke, cardiovascular death, unstable angina and heart failure). Cox regression was used to quantify the association between CAC severity and time to first MACE. Covariates were age, sex, smoking status and history, BMI and baseline CVD. Results: 12,388 participants had baseline LDCT with CAC assessment. At 4.9 years median follow up, 618 MACE had accrued. Median age was 65, 58% were men and 49% were current smokers. 27%, 42%, 21% and 10% of all participants had no, mild, moderate and severe CAC. Compared to no CAC, increasing CAC severity was associated with increasing MACE risk: mild (aHR 2.03 (95%CI 1.51-2.73)), moderate (aHR 3.37 (95%CI 2.47-4.59)) and severe (aHR 4.67 (95%CI 3.35-6.51)). Conclusions: We identify a high burden of incidental CAC in our LCS population. Even mild CAC doubles MACE risk. This has significant implications for guidelines on reporting CAC and managing CVD risk in LCS populations.

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