While smoking is a known cause of lung cancer, it also causes cardiovascular disease. In fact, according to data from the National Lung Screening Trial, atherosclerotic cardiovascular disease (ASCVD), not lung cancer, is the leading cause of death for individuals receiving lung cancer screening (LCS).
Tailor
“This speaks to the significant need for cardiovascular risk stratification and reduction in the lung cancer screening population,” said Tina Tailor, MD, an assistant professor of radiology at Duke University Medical Center.
According to Dr. Tailor, a cardiovascular risk reduction strategy may include coronary artery calcification (CAC), a key biomarker for ASCVD.
“It’s not unusual to find CAC in individuals screened for lung cancer,” Dr. Tailor said. “However, while the American Heart Association (AHA) guidelines include CAC as a risk-enhancing factor for preventative statin therapy, the role of CAC in the lung cancer screening population is unclear.”
Speaking at a Thursday session, Dr. Tailor shared the results of a recent study on the effects of CAC on statin prescription.
“Our purpose was to determine the proportion of lung cancer screening individuals eligible for statin therapy for primary prevention, assess the rate of statin prescription amongst statin-eligible patients, and determine the impact of lung cancer screening-reported CAC on downstream statin initiation,” Dr. Tailor explained.
A Significant Disconnect
The study was a retrospective review of electronic health record data of patients undergoing baseline lung cancer screening at three academic institutions and their affiliated hospitals. A total of 5,495 individuals received lung cancer screening during the span of the study.
After excluding those with pre-existing clinical ASCVD, the majority of patients (73.6%) were determined to be statin-eligible per the AHA guidelines. “Yet most statin-eligible individuals were not on a statin at the time of the lung cancer screening, which shows a significant disconnect between those who are eligible for statin and those actually receiving it,” Dr. Tailor said.
CAC and Downstream Statin Prescription
The study also examined how the presence of CAC impacted the likelihood of statin prescription after the lung cancer screening exam. Researchers found that 10% of those with CAC received a statin prescription, whereas only 3% of patients without CAC received downstream statin prescriptions.
“We found a significant increase in statin prescription for individuals with lung cancer screening reported CAC,” Dr. Tailor said. “Additionally, the likelihood of downstream statin prescription was higher in patients with increasing CAC severity – all of which indicates a positive trend towards statin prescription with the reporting of CAC by radiologists.”
Increasing the Likelihood for a Statin Prescription
The study demonstrates that although the majority of the lung cancer screening population meets guidelines for preventative statin therapy, statins remain grossly under-prescribed.
“The majority of the lung cancer screening population is at high ASCVD risk and eligible for preventative statin therapy,” Dr. Tailor concluded. “Considering the correlation between CAC and likelihood for receiving a statin prescription, radiologists should consider reporting both CAC and severity at the lung cancer screening exam.”
For More Information:
View the Cardiovascular Risk in the Lung Cancer Screening Population: A Multicenter Study Evaluating the Effects of Coronary Artery Calcification on Statin Delivery — PS40 at RSNA2020.RSNA.org.
