B102-01 Linking Lungs and Heart: Centrilobular Emphysema Predicts Coronary Artery Calcification Progression During 18 Years of Follow-up

Abstract Rationale Low-dose chest computed tomography(LDCT) for lung cancer screening provides an opportunity to evaluate smoking-related comorbidities such as emphysema and coronary artery calcification(CAC). Although cross-sectional associations exist, the long-term relationship between emphysema subtypes and CAC progression remains undefined. Methods A random sample of 256 participants with ≥15 years of follow-up was selected from a prospective cohort of 9.047 asymptomatic, high-risk individuals enrolled in the Mount Sinai Early Lung and Cardiac Action Program(New York, June2000-August2004). Emphysema and its two subtypes—centrilobular(CLE) and paraseptal(PSE)—were visually assessed and graded using an enhanced Fleischner Society classification. CAC was scored using a validated ordinal method. Progression was defined as any increase in total score from baseline to follow-up. Logistic regression was used to identify predictors of CAC progression, including CLE and PSE progression, adjusted for age, smoking status, and pack-years. Results Among 256 participants(50%women, 50%men;median age, 58 yearsIQR,52-63), most (69.1%) were former smokers at enrollment, with a median of 31.1 pack-yearsIQR,21-49. Progression of CAC and emphysema was observed in 182(71.7%) and 145(56.6%) participants, respectively, over a median follow-up of 18.3(IQR:16.7,20.5) years. Participants with CAC progression had significantly higher rates of any emphysema both at baseline(70.9%vs.54.2%; p = 0.011) and at follow-up(75.8%vs.56.9%;p=0.003). This group also showed higher median CLE scores at baseline(2.00vs.0.00;p0.001) and follow-up(5.00 vs. 0.00; p 0.001). In multivariable logistic regression adjusted for age, smoking status, and pack-years, CLE progression was strongly associated with CAC progression(OR 3.32; 95% CI, 1.75-6.63; p 0.001). In contrast, PSE showed no significant association with CAC progression(OR1.17; 95%CI,0.32-5.64;p=0.83). Conclusions In this long-term screening cohort, progression of CLE—but not PSE—was linked to CAC progression, highlighting the value of detailed emphysema assessment in screening programs and supporting CLE as a systemic disorder with prognostic relevance. This abstract is funded by: Simons Foundation International.