Author(s): Balata H.; Blandin Knight S.; Barber P.; Evison M.; Booton R.; Crosbie P.A.J.; Colligan D.; Taylor S.; Tonge J.; Waplington S.; Crosbie E.J.; Duerden R.; Greaves M.; Sawyer R.; Sharman A.; Smith E.; Elton P.; Howells J.; Irion K.; Karunaratne D.; Kirwan M.; Slevin K.; Macnab A.; Miller C.; Mellor S.; Newton T.; Novasio J.; Taylor B.; Walsham A.; Whittaker J.
Source: Lung Cancer; Oct 2018; vol. 124 ; p. 148-153
Publication Date: Oct 2018
Publication Type(s): Article
Abstract:Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention.
Methods: The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk >=1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (+/-5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score >=10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score.
Results: Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 +/- 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention.
Discussion: Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.Copyright © 2018 Elsevier B.V.
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