High prevalence of atherosclerosis detected in patients entering lung cancer therapy
Key takeaways:
- Patients with lung cancer have a high prevalence of atherosclerosis.
- These patients may benefit from calcium scoring.
- Researchers identified specific risk factors linked to atherosclerosis in this population.
CT imaging of patients entering lung cancer treatment identified a high prevalence of atherosclerosis, according to data presented at the American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient course.
The researchers hypothesized that due to the high prevalence of atherosclerosis in this population, patients entering lung cancer treatment may benefit from coronary calcium scoring.
“Over the past few years, we have been looking at various cancer groups and the presence of CV risk factors present at the time of their diagnosis. We have looked at breast, lung and gynecologic cancer patients thus far. We have found that all of these groups, including lung cancer patients, have known CV risk factors present when they are diagnosed with cancer. As expected in the lung cancer population, tobacco smoking history is prevalent. More importantly, we utilized CT imaging obtained for initial cancer staging purposes to look for the presence of coronary or aortic atherosclerosis in the form of calcified plaque,” Christopher Malozzi, DO, director of cardio-oncology services at the University of South Alabama Frederick P. Whiddon College of Medicine, told Healio. “This identifies patients with atherosclerosis prior to entering cancer treatment. This and other CV risk factors place these patients at a higher risk for both cancer treatment-related cardiotoxicity and poorer outcomes. It also helps to identify a group of patients that would benefit from aggressive CV risk factor modification.”
The present study included 276 patients entering lung cancer treatment who underwent chest CT. Their CT scans underwent retrospective chart review for presence of coronary or aortic atherosclerosis.
Among participants, 47.8% had systolic BP of 130 mm Hg or more; 38% had diastolic BP of 80 mm Hg or more; 27.2% had obesity; and 88.8% were active or former tobacco users.
Overall, 77.9% had atherosclerosis visible on retrospective CT review.
The researchers reported that both tobacco use and age 65 years or older were significantly associated with increased odds of atherosclerosis visible on CT.
“I was not surprised by the number of patients who already had atherosclerosis once diagnosed with lung cancer,” Malozzi told Healio. “It is well known that tobacco use is a strong risk factor for the development of heart disease and lung cancer. What this study confirms is that tobacco use is a shared risk factor for both diseases and at the time of lung cancer diagnosis these patients should be considered for additional evaluation by a cardiologist or cardio-oncologist, as it is likely they already have CV disease.”
Not only did white patients entering lung cancer treatment have more atherosclerosis compared with Black patients, but white smokers were the most likely of all subgroups to have atherosclerosis on CT, according to the study.
Moreover, patients with large cell and non-small cell squamous cell carcinoma had higher prevalence of atherosclerosis compared with patients with non-small cell adenocarcinoma and small cell lung cancers.
“While this study did not employ coronary calcium scoring, we utilized already available imaging to look for the presence of coronary calcium,” Malozzi told Healio. “Whether a true calcium score is generated or not, this study points to the concept of utilizing imaging, even if is obtained for other purposes, to provide insight into what other health problems might be present that could impact a patient's care. It has been suggested that calcium scoring would be feasible when patients present for their routine low-dose CT lung cancer screening tests. Regardless of how imaging is used in the future, this study highlights the importance of using any available information at hand to provide the most comprehensive care possible, especially in cancer patients with CV disease or CV risk.”
For more information:
Christopher Malozzi, DO, can be reached at 5795 USA Drive North, CSAB 170, Mobile, AL 36688.
Reference:
- Research suggests comprehensive CT scans may help identify atherosclerosis among lung cancer patients. https://www.acc.org/About-ACC/Press-Releases/2025/02/14/19/03/Research-Suggests-Comprehensive-CT-Scans-May-Help-Identify-Atherosclerosis-Among-Lung-Cancer-Patients. Published Feb. 14, 2025. Accessed Feb. 14, 2025.
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Malozzi C. Implementation science (application of research into practice/policy). Presented at: American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient course; Feb. 14-16, 2025; Washington, D.C.