Author + information
- Received November 7, 2012
- Revision received February 8, 2013
- Accepted February 14, 2013
- Published online August 1, 2013.
- Onno M. Mets, MD, PhD∗,
- Rozemarijn Vliegenthart, MD, PhD†,
- Martijn J. Gondrie, PhD∗,
- Max A. Viergever, PhD‡,
- Matthijs Oudkerk, MD, PhD†,
- Harry J. de Koning, MD, PhD§,
- Willem P.Th.M. Mali, MD, PhD∗,
- Mathias Prokop, MD, PhD⋮,
- Rob J. van Klaveren, MD, PhD¶,
- Yolanda van der Graaf, MD, PhD#,
- Constantinus F.M. Buckens, MD#,
- Pieter Zanen, MD, PhD∗∗,
- Jan-Willem J. Lammers, MD, PhD∗∗,
- Harry J.M. Groen, MD, PhD††,
- Ivana Isgum, PhD‡ and
- Pim A. de Jong, MD, PhD∗∗ ()
- ∗Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- †Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands
- ‡Images Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- §Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
- ⋮Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- ¶Department of Pulmonology, Lievensberg Ziekenhuis, Bergen op Zoom, Bergen op Zoom, the Netherlands
- #Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- ∗∗Department of Pulmonology, University Medical Center Utrecht, Utrecht, the Netherlands
- ††Department of Pulmonology, University Medical Center Groningen, Groningen, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Pim A. de Jong, University Medical Center Utrecht, Heidelberglaan 100, E.01.132, 3508GA Utrecht, the Netherlands.
Objectives The aim of this study was to derivate and validate a prediction model for cardiovascular events based on quantification of coronary and aortic calcium volume in lung cancer screening chest computed tomography (CT).
Background CT-based lung cancer screening in heavy smokers is a very timely topic. Given that the heavily smoking screening population is also at risk for cardiovascular disease, CT-based screening may provide the opportunity to additionally identify participants at high cardiovascular risk.
Methods Inspiratory screening CT of the chest was obtained in 3,648 screening participants. Next, smoking characteristics, patient demographics, and physician-diagnosed cardiovascular events were collected from 10 years before the screening CT (i.e., cardiovascular history) until 3 years after the screening CT (i.e., follow-up time). Cox proportional hazards analysis was used to derivate and validate a prediction model for cardiovascular risk. Age, smoking status, smoking history, and cardiovascular history, together with automatically quantified coronary and aortic calcium volume from the screening CT, were included as independent predictors. The primary outcome measure was the discriminatory value of the model.
Results Incident cardiovascular events occurred in 145 of 1,834 males (derivation cohort) and 118 of 1,725 males and 2 of 89 females (validation cohort). The model showed good discrimination in the validation cohort with a C-statistic of 0.71 (95% confidence interval: 0.67 to 0.76). When high risk was defined as a 3-year risk of 6% and higher, 589 of 1,725 males were regarded as high risk and 72 of 118 of all events were correctly predicted by the model.
Conclusions Quantification of coronary and aortic calcium volumes in lung cancer screening CT images—information that is readily available—can be used to predict cardiovascular risk. Such an approach might prove useful in the reduction of cardiovascular morbidity and mortality and may enhance the cost-effectiveness of CT-based screening in heavy smokers.
The NELSON trial was sponsored by the Netherlands Organization for Health Research and Development (ZonMw); Dutch Cancer Society Koningin Wilhelmina Fonds (KWF); Stichting Central Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen (RvvZ); Roche Diagnostics, Siemens Germany; Rotterdam Oncologic Thoracic Steering committee (ROTS); and G.Ph.Verhagen Trust, Flemish League Against Cancer, Foundation Against Cancer, and Erasmus Trust Fund. Drs. Viergever and Isgum received a research grant of the Ministry of Economic Affairs in the Netherlands, and the work was financially supported by the project Care4Me in the framework of the EU research program ITEA2; the grant also covered travel expenses. Dr. Viergever has also received a grant from Philips Healthcare. Dr. Prokop has received a research grant from Toshiba; and served on the speakers' bureau for Bayer, Bracco, and Toshiba. Dr. Zanen received a research grant as part of the EU FP7 subsidy system. Dr. Isgum is funded by the Foundation for Technological Sciences, the Netherlands, Pie Medical Imaging, and 3mensio Medical Imaging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Mets, Isgum, and de Jong contributed equally to this article.
- Received November 7, 2012.
- Revision received February 8, 2013.
- Accepted February 14, 2013.
- American College of Cardiology Foundation