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

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

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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Belgium / epidemiology
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Early Detection of Cancer*
  • Forced Expiratory Volume
  • Humans
  • Imaging, Three-Dimensional
  • Incidence
  • Lung Neoplasms / complications
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / physiopathology
  • Male
  • Mass Screening*
  • Middle Aged
  • Netherlands / epidemiology
  • Prognosis
  • Risk Factors
  • Spirometry
  • Tomography, X-Ray Computed / methods*
  • Vital Capacity

Associated data

  • ISRCTN/ISRCTN63545820