Lung cancer patients with higher level of coronary calcium at increased risk for adverse cardiovascular events

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Lung cancer patients with higher amounts of coronary artery calcium have an increased risk of an adverse cardiovascular event as a result of thoracic radiation therapy compared to patients with no coronary artery calcium. This is according to the findings of a study being presented at the American College of Cardiology’s (ACC’s) Advancing the Cardiovascular Care of the Oncology Patient course (11‒12 February, virtual).

Researchers at Washington University in St Louis, St Louis, USA looked at non-small cell lung cancer patients who underwent non-contrast chest computed tomography (CT) scans for treatment planning between 2001 to 2014 to evaluate coronary artery calcium.

“Recognising patients with a high burden of coronary artery calcium allows for the implementation of risk modification therapies to reduce cardiovascular risk, such as aspirin and statin therapy. In addition, recognising cardiovascular risk allows the care team to make a better assessment of the patient’s overall prognosis, which can guide therapy choice and goals of care discussions,” said Matthew Lui, an internal medicine resident at Washington University in St Louis and the study’s lead author.

Patients were stratified into no, mild, moderate and severe coronary artery calcium groups. Data on demographics, comorbidities and radiation treatment characteristics were also gathered for inclusion. The researchers then assessed the incidence of major adverse cardiovascular events, such as heart attack or stroke, after initiation of radiation therapy across the coronary artery calcium groups.

The study included 155 patients, which included 41 patients with no coronary artery calcium, 45 patients with mild coronary artery calcium, 39 patients with moderate coronary artery calcium and 30 patients with severe coronary artery calcium.

Researchers report that there were three major adverse cardiovascular events in the no coronary artery calcium group, seven events in the mild group, five in the moderate group and five in the severe group. Average and max radiation dose to the heart were not associated with a major adverse cardiovascular event in the researchers’ time to event analysis.

After adjusting for age and sex, coronary artery calcium group was associated with increased risk of major adverse cardiovascular events. When compared to no coronary artery calcium, the mild group was associated with 11.7 times increased risk for a major adverse cardiovascular event and severe coronary artery calcium had a 21.4 times increased risk. Moderate coronary artery calcium showed a trend toward increased risk.

“Coronary artery calcium burden is an important risk factor in patients with non-small cell lung cancer undergoing thoracic radiation and may be a useful indicator in cardiac risk-stratification of these patients,” Lui said. “We believe further study evaluating the utility of coronary artery calcium burden in determining cardiovascular risk in other cancer populations is warranted and can help validate coronary artery calcium burden across different populations.”


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