• Marcella Cabral Caires, Keren Mbondo Kasuku, Bethlehem Mengesha, Habibat Garuba, Angeline Law, Christopher Johnson, David Ian Paterson, Carole Dennie, Elena Pena, Li Chen, ChowBenjamin J WBJWMedicine Division of Cardiology, (Cabral Caires, Mbondo Kasuku, Mengesha, Paterson, Chen, Chow, Small), University of Ottawa Heart Institute; Department of Cardiology (Garuba, Law, Johnson), The Ottawa Hospital; Department of Radiology , and Gary R Small.
• Medicine Division of Cardiology, (Cabral Caires, Mbondo Kasuku, Mengesha, Paterson, Chen, Chow, Small), University of Ottawa Heart Institute; Department of Cardiology (Garuba, Law, Johnson), The Ottawa Hospital; Department of Radiology (Dennie, Pena), University of Ottawa, Ottawa, Ont.
• CMAJ. 2024 Dec 1; 196 (41): E1362E1369E1362-E1369.

BackgroundLow-dose chest computed tomography (CT) is used for lung cancer screening, but can also detect coronary artery disease as coronary artery calcium. We sought to determine the prevalence and prognostic utility of coronary artery calcium in a population at high risk of cancer.MethodsWe reviewed CT scans from consecutive participants screened for lung cancer between March 2017 and November 2018 as part of the Ontario Health Lung Cancer Screening Pilot for People at High Risk. We quantified coronary artery calcium using an estimated Agatston score. We identified the composite primary outcome of all-cause death and cardiovascular events using linked electronic medical record data from The Ottawa Hospital to December 2023.ResultsAmong 1486 people who underwent screening CT, coronary artery calcium was detected in 1232 (82.9%) and was extensive in 439 (29.5%). On multivariable analysis, extensive coronary artery calcium was associated with the composite primary outcome (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.35-3.38), all-cause death (HR 2.39, 95% CI 1.34-4.27), and cardiovascular events (HR 2.06, 95% CI 1.13-3.77). Extensive coronary artery calcium remained predictive of cardiovascular events after we adjusted for noncardiovascular death as a competing risk (HR 2.05, 95% CI 1.09-3.85).InterpretationAmong people undergoing low-dose chest CT for lung cancer screening, extensive coronary artery calcium was an independent predictor of all-cause death and cardiovascular events, even after adjustment for noncardiovascular death. The opportunity to identify and reduce risks from coronary artery disease may represent an additional benefit of lung cancer screening.© 2024 CMA Impact Inc. or its licensors.

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