52 Prevalence of coronary artery calcification in patients with early stage lung cancer and missed opportunities for cardiovascular risk optimization

Introduction Cardiovascular (CV) disease is a leading cause of morbidity and mortality in cancer survivors. Patients with lung cancer often have traditional CVD risk factors.Quantification of coronary artery calcium (CAC) on gated noncontrast cardiac CT, as a screening test for subclinical coronary artery disease, is a proven tool for the prediction of long-term cardiovascular risk. CAC may also be incidentally identified on noncontrast nongated chest CT imaging (NCCT) performed during evaluation of patients with lung cancer. This presents an opportunity to modify CV risk in this cancer cohort. Aims To determine the prevalence of CAC among patients with a new diagnosis of early stage non-small cell lung cancer (NSCLC) To investigate if the incidental finding of CAC in patients with NSCLC who were not on the combination of aspirin (ASA) and statin prompted initiation of these agents at any time within the following 6 months. Methods We carried out a single center, retrospective cohort study of 143 patients referred to thoracic surgery with early stage NSCLC who had undergone noncontrast CT chest imaging prior to surgery. Baseline demographics, cardiovascular risk factors, oncological history, as well as usage of anti-platelet and lipid lowering agents, were determined from review of electronic medical record review. All NCCTs were independently reviewed by two readers with training in advanced CV imaging using validated techniques to identify and grade severity of CAC. Medications usage at 6 months following NCCT was assessed to determine if the incidental finding of CAC in patients without pre-existing diagnoses of coronary artery disease (CAD), peripheral arterial disease (PAD), or cerebrovascular disease (CVD), prompted prescription of anti-platelet and lipid lowering agents. Data on absolute and relative contraindications to prescription of these agents, and on any new CV events in this intervening period were also sought. Results Of the 143 patients included in this study, the mean age was 67 years (range 41–88), and 42% were male. Image quality was adequate to evaluate for CAC in 138 (96.5%) of patients. CAC was detected in 109 (79%) patients; 68 of these patients had no pre-existing diagnosis of CAD, PAD, or CVD. Of these 68 patients, 37 were on ASA, a statin or both at baseline. At 6 months following the incidental finding of CAC on NCCT, only 3 additional patients had been commenced on ASA and none on a statin. Conclusion CAC is a very prevalent finding on NCCT chest imaging performed in patients with early stage lung cancer, but does not prompt prescription of antiplatelet and/or lipid lower agents in the majority of cases. The finding of subclinical coronary atherosclerosis during staging NCCT chest imaging presents an opportunity for interventions that could improve cardiovascular outcomes in this cohort of cancer patients.