Clinical Impact of Reporting Coronary Artery Calcium Scores of Non-Gated Chest Computed Tomography on Statin Management

Douthit, Nathan T; Wyatt, Nicole; Schwartz, Brandon

doi:10.7759/cureus.14856

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…CAC screening using nongated CT has become an increasingly available and consistently reproducible means for stratifying ASCVD risk and guiding statin therapy in individuals with equivocal ASCVD risk scores. [24][25][26] As has been demonstrated in previous studies, our study additionally highlights the effective use of LDCT in not only identifying CAC, but also in beneficially impacting statin decisions in the high-risk smoking population. [24][25][26] Our results also showed LDCT missed CAC in participants, the majority of which were already on a statin, and only 1 nonstatin individual benefited from additional CAC reporting.…”

Section: Discussionsupporting

confidence: 79%

“…[24][25][26] As has been demonstrated in previous studies, our study additionally highlights the effective use of LDCT in not only identifying CAC, but also in beneficially impacting statin decisions in the high-risk smoking population. [24][25][26] Our results also showed LDCT missed CAC in participants, the majority of which were already on a statin, and only 1 nonstatin individual benefited from additional CAC reporting. CAC scoring on LDCT should be an adjunct, not a substitute, for ASCVD risk stratification to help guide statin management.…”

Section: Discussionsupporting

confidence: 79%

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Reporting Coronary Artery Calcium on Low-Dose Computed Tomography Impacts Statin Management in a Lung Cancer Screening Population

Chin¹

2022

Federal Practitioner

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Background: Cigarette smoking is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Concomitant use of low-dose computed tomography (LDCT) for coronary artery calcium (CAC) scoring with lung cancer screening (LCS) has been proposed to further determine ASCVD risk and mortality. We aimed to determine the validity of LDCT in identifying CAC and its impact on statin management. Methods: We conducted a retrospective review from November 2020 to May 2021 of Military Health System (MHS) beneficiaries who received LCS with LDCT and were referred for CAC scoring with electrocardiogram-gated CT. Of the 190 participants initially identified, 170 met study eligibility. The Agatston method was used to score CAC on both scan types. Results: Participants had a mean (SD) age of 62.1 (4.6) years and were 70.6% male. CAC was seen more on ECG-gated CT compared with LDCT (88% vs 74%, P < .001). The Spearman correlation and Kendall W coefficient of concordance of CAC scores between the 2 scan types was 0.945 (P < .001) and 0.643, respectively. The κ statistic between CAC scores on the 2 different scans was 0.49 (SEκ = 0.048; 95% CI, -0.726-1.706), and the weighted κ statistic was 0.711. Bland-Altman analysis demonstrated a mean bias of 111.45 Agatston units, with limits of agreement between -268.64 and 491.54, suggesting CAC scores on electrocardiogram-gated CT were on average about 111 units higher than those on LDCT. There was a statistically significant proportion of nonstatin participants who met statin criteria based on additional CAC reporting (P < .001). Conclusions: CAC scores are highly correlated and concordant between LDCT and electrocardiogram-gated CT. Smokers undergoing annual LDCT may benefit from concomitant CAC scoring to help stratify ASCVD risk.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 79%

Reporting Coronary Artery Calcium on Low-Dose Computed Tomography Impacts Statin Management in a Lung Cancer Screening Population

Chin¹

2022

Federal Practitioner

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“…Additionally, clinicians should utilize the diagnostic tests used in cancer management to help risk stratify ASCVD risk. For example, coronary artery calcifications on chest imaging are associated with clinically significant ASCVD ( 170 , 171 ). Moreover, baseline testing prior to anthracycline initiation, which includes ECG, echocardiogram, and occasionally cardiac magnetic resonance imaging, should be reviewed thoroughly for evidence of subclinical CAD ( 172 – 174 ).…”

Section: Discussionmentioning

confidence: 99%

Cancer therapy's impact on lipid metabolism: Mechanisms and future avenues

Bhatnagar

Dixit²,

Yang³

et al. 2022

Front. Cardiovasc. Med.

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Atherosclerotic cardiovascular disease is a growing threat among cancer patients. Not surprisingly, cancer-targeting therapies have been linked to metabolic dysregulation including changes in local and systemic lipid metabolism. Thus, tumor development and cancer therapeutics are intimately linked to cholesterol metabolism and may be a driver of increased cardiovascular morbidity and mortality in this population. Chemotherapeutic agents affect lipid metabolism through diverse mechanisms. In this review, we highlight the mechanistic and clinical evidence linking commonly used cytotoxic therapies with cholesterol metabolism and potential opportunities to limit atherosclerotic risk in this patient population. Better understanding of the link between atherosclerosis, cancer therapy, and cholesterol metabolism may inform optimal lipid therapy for cancer patients and mitigate cardiovascular disease burden.

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Prevalence and clinical implications of coronary artery calcium scoring on non-gated thoracic computed tomography: a systematic review and meta-analysis

Osborne-Grinter,

Ali,

Williams

2023

Eur Radiol

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Objectives Coronary artery calcifications (CACs) indicate the presence of coronary artery disease. CAC can be found on thoracic computed tomography (CT) conducted for non-cardiac reasons. This systematic review and meta-analysis of non-gated thoracic CT aims to assess the clinical impact and prevalence of CAC. Methods Online databases were searched for articles assessing prevalence, demographic characteristics, accuracy and prognosis of incidental CAC on non-gated thoracic CT. Meta-analysis was performed using a random effects model. Results A total of 108 studies (113,406 patients) were included (38% female). Prevalence of CAC ranged from 2.7 to 100% (pooled prevalence 52%, 95% confidence interval [CI] 46–58%). Patients with CAC were older (pooled standardised mean difference 0.88, 95% CI 0.65–1.11, p < 0.001), and more likely to be male (pooled odds ratio [OR] 1.95, 95% CI 1.55–2.45, p < 0.001), with diabetes (pooled OR 2.63, 95% CI 1.95–3.54, p < 0.001), hypercholesterolaemia (pooled OR 2.28, 95% CI 1.33–3.93, p < 0.01) and hypertension (pooled OR 3.89, 95% CI 2.26–6.70, p < 0.001), but not higher body mass index or smoking. Non-gated CT assessment of CAC had excellent agreement with electrocardiogram-gated CT (pooled correlation coefficient 0.96, 95% CI 0.92–0.98, p < 0.001). In 51,582 patients, followed-up for 51.6 ± 27.4 months, patients with CAC had increased all cause mortality (pooled relative risk [RR] 2.13, 95% CI 1.57–2.90, p = 0.004) and major adverse cardiovascular events (pooled RR 2.91, 95% CI 2.26–3.93, p < 0.001). When CAC was present on CT, it was reported in between 18.6% and 93% of reports. Conclusion CAC is a common, but underreported, finding on non-gated CT with important prognostic implications. Clinical relevance statement Coronary artery calcium is an important prognostic indicator of cardiovascular disease. It can be assessed on non-gated thoracic CT and is a commonly underreported finding. This represents a significant population where there is a potential missed opportunity for lifestyle modification recommendations and preventative therapies. This study aims to highlight the importance of reporting incidental coronary artery calcium on non-gated thoracic CT. Key Points • Coronary artery calcification is a common finding on non-gated thoracic CT and can be reliably identified compared to gated-CT. • Coronary artery calcification on thoracic CT is associated with an increased risk of all cause mortality and major adverse cardiovascsular events. • Coronary artery calcification is frequently not reported on non-gated thoracic CT.

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Clinical Impact of Reporting Coronary Artery Calcium Scores of Non-Gated Chest Computed Tomography on Statin Management

Cited by 3 publications

References 21 publications

Reporting Coronary Artery Calcium on Low-Dose Computed Tomography Impacts Statin Management in a Lung Cancer Screening Population

Reporting Coronary Artery Calcium on Low-Dose Computed Tomography Impacts Statin Management in a Lung Cancer Screening Population

Cancer therapy's impact on lipid metabolism: Mechanisms and future avenues

Prevalence and clinical implications of coronary artery calcium scoring on non-gated thoracic computed tomography: a systematic review and meta-analysis

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