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Randomized Controlled Trial
. 2015 Jan;25(1):65-71.
doi: 10.1007/s00330-014-3384-6. Epub 2014 Sep 3.

Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

Richard A P Takx  1 , Rozemarijn Vliegenthart, Firdaus A A Mohamed Hoesein, Ivana Išgum, Harry J de Koning, Willem P Th M Mali, Carlijn M van der Aalst, Pieter Zanen, Jan-Willem J Lammers, Harry J M Groen, Eva M van Rikxoort, Michael Schmidt, Bram van Ginneken, Matthijs Oudkerk, Tim Leiner, Pim A de Jong
Affiliations
Randomized Controlled Trial

Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

Richard A P Takx et al. Eur Radiol. 2015 Jan.

Abstract

Objective: The objective of this study was to investigate the association of spirometry and pulmonary CT biomarkers with cardiovascular events.

Methods: In this lung cancer screening trial 3,080 male participants without a prior cardiovascular event were analysed. Fatal and non-fatal cardiovascular events were included. Spirometry included forced expiratory volume measured in units of one-second percent predicted (FEV1%predicted) and FEV1 divided by forced vital capacity (FVC; FEV1/FVC). CT examinations were quantified for coronary artery calcium volume, pulmonary emphysema (perc15) and bronchial wall thickness (pi10). Data were analysed via a Cox proportional hazard analysis, net reclassification improvement (NRI) and C-indices.

Results: 184 participants experienced a cardiovascular event during a median follow-up of 2.9 years. Age, pack-years and smoking status adjusted hazard ratios were 0.992 (95% confidence interval (CI) 0.985-0.999) for FEV1%predicted, 1.000 (95%CI 0.986-1.015) for FEV1/FVC, 1.014 (95%CI 1.005-1.023) for perc15 per 10 HU, and 1.269 (95%CI 1.024-1.573) for pi10 per 1 mm. The incremental C-index (<0.015) and NRI (<2.8%) were minimal. Coronary artery calcium volume had a hazard ratio of 1.046 (95%CI 1.034-1.058) per 100 mm(3), an increase in C-index of 0.076 and an NRI of 16.9% (P < 0.0001).

Conclusions: Pulmonary CT biomarkers and spirometry measurements were significantly associated with cardiovascular events, but did not contain clinically relevant independent prognostic information for cardiovascular events.

Key points: • Pulmonary CT biomarkers and spirometry are associated with cardiovascular events • These pulmonary measurements do not contain clinically relevant independent prognostic information • Only coronary calcium score improved cardiovascular risk prediction above age and smoking.

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