Use of coronary artery calcium testing to improve coronary heart disease risk assessment in a lung cancer screening population: the Multi-Ethnic Study of Atherosclerosis (MESA)
Open accessAbstract
Background Assessment of coronary artery calcium (CAC) during lung cancer screening chest computed tomography (CT) represents an opportunity to identify asymptomatic individuals at increased coronary heart disease (CHD) risk. We determined the improvement in CHD risk prediction associated with the addition of CAC testing in a population recommended for lung cancer screening.Methods We included 484 out of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants without baseline cardiovascular disease who met U.S. Preventive Service Task Force CT lung cancer screening criteria and underwent gated CAC testing. 10 year-predicted CHD risks with and without CAC were calculated using a validated MESA-based risk model and categorized into low (<5%), intermediate (5%-10%), and high (≥10%). The net reclassification improvement (NRI) and change in Harrell's C-statistic by adding CAC to the risk model were subsequently determined.Results Of 484 included participants (mean age = 65; 39% women; 32% black), 72 (15%) experienced CHD events over the course of follow-up (median = 12.5 years). Adding CAC to the MESA CHD risk model resulted in 17% more participants classified into the highest or lowest risk categories and a NRI of 0.26 (p = 0.001). The C-statistic improved from 0.538 to 0.611 (p = 0.01).Conclusions CHD event rates were high in this lung cancer screening eligible population. These individuals represent a high-risk population who merit consideration for CHD prevention measures regardless of CAC score. Although overall discrimination remained poor with inclusion of CAC scores, determining whether those reclassified to an even higher risk would benefit from more aggressive preventive measures may be important.
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In the Multi-Ethnic Study of Atherosclerosis, 41-57% of statin-eligible individuals had a coronary artery calcium score of zero, and the 10-year atherosclerotic cardiovascular disease event rate was low at 1.5-4.9%.
“Data from the Multi-Ethnic Study of Atherosclerosis (MESA) showed that 41-57% of individuals who would be eligible for statin therapy had a CAC score of zero and the rate of atherosclerotic CVD events in the 10 year follow-up period was low (1.5-4.9%) [26].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [26]
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- Authors
- Garg, P. K., Jorgensen, N. W., McClelland, R. L., Leigh, J. A., Greenland, P., Blaha, M. J., Yoon, A. J., Wong, N. D., Yeboah, J., & Budoff, M. J.
- Affiliations
- University of Southern California (US)
- University of Washington (US)
- Atrium Health Wake Forest Baptist (US)
- Northwestern University (US)
- Johns Hopkins University (US)
- University of California, Irvine (US)
- The Lundquist Institute (US)
- Corresponding author
- Garg, Parveen K.
- Jorgensen, Neal W.
- McClelland, Robyn L.
- Leigh, J. Adam
- Greenland, Philip
- Blaha, Michael J.
- Yoon, Andrew J.
- Wong, Nathan D.
- Yeboah, Joseph
- Budoff, Matthew J.
- ORCID
- Venue
- Journal of Cardiovascular Computed Tomography
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 12
- Issue
- 6
- Pages
- 493-499
- ISSN
- 1876-861X (ISSN-L)
- 1934-5925
- PMC
- PMC6585432
- OpenAlex
- W2895547458
- Cited by
- 26
- References
- 38
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2022: 3 · 2021: 8 · 2020: 2 · 2019: 6
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of cardiovascular computed tomography (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169)
- NCATS (UL1-TR-000040, UL1-TR-001079, UL1-TR-001420)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- coronary artery calcium, coronary heart disease risk prediction, lung cancer screening, CT lung cancer screening, risk reclassification, cardiovascular risk prediction models, Multi-Ethnic Study of Atherosclerosis, net reclassification improvement, concordance index, cardiovascular disease prevention
- MeSH terms
- Computed Tomography Angiography, Aged, Aged, 80 and over, Coronary Artery Disease, Coronary Vessels, Female, Humans, Lung Neoplasms, Male, Middle Aged, Predictive Value of Tests, Prognosis, Risk Factors, Time Factors, United States, Coronary Angiography, Early Detection of Cancer, Vascular Calcification
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