CAC tied to MI, stroke risk in non-small cell lung cancer treated with thoracic radiation
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Discovery of coronary artery calcium in patients with non-small cell lung cancer undergoing thoracic radiation was associated with elevated risk for MI and stroke, even when found in small amounts, researchers reported.
According to data presented at the American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient virtual course, radiation dose was not tied to risk for major adverse CV events in patients with non-small cell lung cancer (NSCLC) undergoing thoracic radiation.
“Recognizing patients with a high burden of coronary artery calcium allows for the implementation of risk modification therapies to reduce cardiovascular risk, such as aspirin and statin therapy. In addition, recognizing cardiovascular risk allows the care team to make a better assessment of the patient’s overall prognosis, which can guide therapy choice and goals of care discussions,” Matthew Lui, MD, internal medicine resident at Washington University in St. Louis, said in a press release.
For the present analysis, researchers included 155 patients with NSCLC who underwent thoracic radiation at Washington University in St. Louis from 2001 to 2014. Participants received noncontrast planning chest CT scans for the evaluation of CAC.
With 8 years of follow-up data, researchers evaluated the incidence of major adverse CV events, including MI and stroke, after initiation of radiation therapy across the spectrum of CAC severity.
According to the study, 41 patients had no CAC, 45 patients had mild CAC, 39 patients had moderate CAC and 30 patients had severe CAC.
Researchers observed major adverse CV events in 7.3% of the no CAC group, 15.6% of the mild CAC group, 12.8% of the moderate CAC group and 16.7% of the severe CAC group.
After adjustment for age and sex, there was a trend toward CAC being associated with increased risk for major adverse CV events in patients with NSCLC who underwent thoracic radiation (P = .069).
Compared with patients with no CAC at baseline, those with low CAC experienced an 11.7 times greater risk for major adverse CV events (95% CI, 1.2-1105; P = .03), and patients with severe CAC experienced a 21.4 times greater risk (95% CI, 1.4-357; P = .03).
Moreover, moderate CAC showed a trend toward increased risk for major adverse CV events compared with no CAC (adjusted HR = 7.4; 95% CI, 0.5-117.5; P = .15).
According to the study, there was no association between mean or maximum radiation dose and risk for major adverse CV events.
“Coronary artery calcium burden is an important risk factor in patients with non-small cell lung cancer undergoing thoracic radiation and may be a useful indicator in cardiac risk stratification of these patients,” Lui said in the release. “We believe further study evaluating the utility of coronary artery calcium burden in determining cardiovascular risk in other cancer populations is warranted and can help validate coronary artery calcium burden across different populations.”
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Lui M. Original Research Abstract 60. Presented at: American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient virtual course; Feb. 11-12, 2022 (virtual meeting).
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