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Combined aortic valve and coronary artery calcifications in lung cancer screening as predictors of death from cardiovascular disease

  • Cardiac
  • Published:
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Abstract

Objectives

Smoking is a major risk factor for both cardiovascular disease (CVD) and lung cancer. Aortic valve calcification (AVC) and coronary artery calcification (CAC) are both due to atherosclerotic disease. We aim to investigate whether AVC on low-dose CT (LDCT) predicts death from CVD in smokers beyond that provided by CAC.

Methods

We reviewed a prospective cohort of 8618 smokers enrolled in LDCT screening for lung cancer in New York State between June 2000 and December 2005. As of December 2009, 169 of the 643 deaths were due to CVD; median follow-up time was 96.4 months. Visual AVC was assessed as being absent (AVC = 0) or present (AVC > 0). CAC ordinal scores of 0–12 were categorized into three validated prognostic categories (0, 1–3, and 4–12). Cox proportional hazards regression analysis was used to assess whether AVC > 0 increased the risk of CVD death, after adjustment for CAC categories and other risk factors.

Results

The prevalence of AVC significantly increased (p < 0.0001) with the increasing severity of the CAC categories; Pearson, Spearman, and Kendall’s correlation coefficients showed a significant correlation between AVC and CAC with r = 0.29, ρ = 0.32, and τB = 0.28 (all p values < 0.0001), respectively. CAC and AVC were significant predictors of CVD death when considered alone using multivariable Cox regression analysis (adjusted HR of CAC = 1.57, p = 0.04; adjusted HR of AVC = 1.39, p = 0.045). When AVC > 0 and CAC ≥ 4, the hazard ratio was 2.35 (95%CI 1.57–3.50) compared with the reference group of AVC = 0 and CAC < 4, when adjusted for other risk factors.

Conclusions

The presence of AVC identified on LDCT is a significant predictor of future CVD death, particularly for those with ordinal CAC score ≥ 4.

Key Points

• Aortic valve calcification (AVC) and coronary artery calcification (CAC) are both due to atherosclerotic disease. The prevalence of AVC in lung cancer screening cohort significantly increased with the increasing severity of CAC.

• CAC and AVC were significant predictors of cardiovascular disease (CVD) death when considered alone. Participants who underwent lung cancer screening with AVC > 0 and CAC ≥ 4 had more than a 2-fold increased risk of CVD death than the group with AVC = 0 and CAC < 4, when adjusted for other risk factors.

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Abbreviations

AVC:

Aortic valve calcification

BMI:

Body mass index

CAC:

Coronary artery calcification

COPD:

Chronic obstructive pulmonary disease

CVD:

Cardiovascular disease

ECG:

Electrocardiographic-gated

HR:

Hazard ratio

HR10packyears :

Hazard ratio for every 10 pack-years increase in smoking

HRage10y :

Hazard ratio for every 10 years of increasing age

IQR:

Interquartile range

LDCT:

Low-dose CT

SCCT/STR:

Society of Cardiovascular Computed Tomography and the Society of Thoracic Radiology

SD:

Standard deviation

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Acknowledgments

This report has been funded in part by the Flight Attendant Medical Research Institute.

Funding

This study was partially funded by the Flight Attendants Medical Research Institute.

Author information

Authors and Affiliations

  1. Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA

    Yeqing Zhu, Rowena Yip, Artit C. Jirapatnakul, David F. Yankelevitz & Claudia I. Henschke

  2. Department of Cardiology, The Grace Ballas Cardiac Research Unit, Sheba Medical Center, Tel Hashomer, Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel

    Joseph Shemesh

Authors
  1. Yeqing Zhu
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  2. Rowena Yip
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  3. Joseph Shemesh
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  4. Artit C. Jirapatnakul
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  5. David F. Yankelevitz
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  6. Claudia I. Henschke
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Corresponding author

Correspondence to Claudia I. Henschke.

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Guarantor

The scientific guarantor of this publication is Dr. Claudia Henschke.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Dr. Yankelevitz is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest including measurement of nodules. Some of these, which are owned by Cornell Research Foundation (CRF), are non-exclusively licensed to General Electric. As an inventor of these patents, Dr. Yankelevitz is entitled to a share of any compensation which CRF may receive from its commercialization of these patents. He is also an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making. Dr. Yankelevitz also serves on the advisory board of GRAIL.

Dr. Henschke is the President and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the Foundation. The Foundation is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Dr. Claudia Henschke is also a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on CT scans of the chest which are owned by Cornell Research Foundation (CRF). Since 2009, Dr. Henschke does not accept any financial benefit from these patents including royalties and any other proceeds related to the patents or patent applications owned by CRF.

The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors have significant statistical expertise (Claudia Henschke and Rowena Yip).

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects have been previously reported for lung findings and coronary artery calcification but results of aortic valve calcification have never been reported.

Methodology

• retrospective

• observational

• performed at one institution

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Zhu, Y., Yip, R., Shemesh, J. et al. Combined aortic valve and coronary artery calcifications in lung cancer screening as predictors of death from cardiovascular disease. Eur Radiol 30, 6847–6857 (2020). https://doi.org/10.1007/s00330-020-07049-4

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  • DOI: https://doi.org/10.1007/s00330-020-07049-4

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