Carotid Doppler ultrasound detected measurable plaques in 33.3% of lung cancer screening participants with absent or limited coronary artery calcification and reclassified an additional 6% of such participants as eligible for lipid-lowering therapy compared to CAC and clinical risk assessment alone (p=0.005).
Observational (n=250)
Yes
Does carotid Doppler ultrasound improve cardiovascular risk assessment and identify eligibility for lipid-lowering therapy in lung cancer screening participants with absent or limited coronary calcifications?
Carotid Doppler ultrasound detects subclinical atherosclerosis in one-third of lung cancer screening participants with limited or absent coronary calcification, identifying additional patients eligible for primary prevention with lipid-lowering therapy.
Effect estimate: McNemar p=0.005
Absolute Event Rate: 49% vs 41%
p-value: p=0.005
Abstract Objectives This study aimed to evaluate the frequency of carotid plaques detected by carotid Doppler ultrasound (CDU) and their potential contribution to therapeutic recommendations, among participants in a lung cancer screening (LCS) programme—notably in those with absent or limited coronary artery calcification (CAC). Materials and methods This prospective study included 250 individuals from the “PEOPLHE” LCS-trial who were evaluated by CDU between November 2022 and August 2023. Stenosis was classified as measurable or severe when > 20% or ≥ 50%, respectively. A health questionnaire was administered to assess conventional cardiovascular (CV) risk factors. Ultra-low-dose computed tomography (ULDCT) scans were analysed using an automated AI-driven CAC quantification software, with CAC expressed as the Agatston score. A retrospective analysis was performed to identify individuals potentially eligible for lipid-lowering therapy initiation by sequentially integrating CT, clinical and CDU data. Results Overall, 122/250 (48.8%) subjects showed measurable carotid plaques, with 18 (7.2%) classified as severe plaques. 80/240 (33.3%) subjects with absent or limited CAC (A0/A1) had measurable plaques, including 10 (55.6%) of the 18 severe plaques. In the retrospective analysis, 23 subjects (23/173, 13.3%) were deemed eligible for lipid-lowering therapy based on CAC data. Among A0/A1, a further 26 individuals were reclassified as eligible: 18/150 (12%) according to conventional CV risk factors, and 8/132 (6%) based solely on CDU findings. Conclusion A considerable proportion of LCS participants showed carotid plaques, confirming subclinical atherosclerosis even in those with absent or limited CAC. CDU, as part of an integrated strategy, may help identify individuals eligible for lipid-lowering therapy. Key Points Question Can CDU improve CV risk assessment by detecting subclinical atherosclerosis in LCS participants with absent or limited coronary calcifications ? Findings Measurable carotid plaques (> 20%) were detected in 33.3% participants with absent or limited coronary calcifications (A0/A1). CDU findings reclassifying 5% of A0/A1 subjects as eligible for lipid-lowering therapy . Clinical relevance CDU may reveal subclinical atherosclerosis in LCS participants with absent or limited coronary calcifications, improving CV risk assessment and identifying individuals who may benefit from lipid-lowering therapy initiation . Graphical Abstract
Mura et al. (Tue,) conducted a observational in Adults aged 50-75 years enrolled in a lung cancer screening program who were current or former smokers (≥15-20 pack-years) without ongoing lipid-lowering therapy, evaluated for subclinical atherosclerosis and coronary artery calcium (n=250). Carotid Doppler Ultrasound (CDU) assessment of carotid plaques vs. Coronary artery calcium (CAC) score based risk assessment alone was evaluated on Eligibility for lipid-lowering therapy based on integrated cardiovascular risk assessment including CAC score, conventional risk factors, and CDU findings (McNemar p=0.005, p=0.005). Carotid Doppler ultrasound detected measurable plaques in 33.3% of lung cancer screening participants with absent or limited coronary artery calcification and reclassified an additional 6% of such participants as eligible for lipid-lowering therapy compared to CAC and clinical risk assessment alone (p=0.005).