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Review
. 2021 Mar 28;13(7):1553.
doi: 10.3390/cancers13071553.

Impact on All-Cause and Cardiovascular Mortality Rates of Coronary Artery Calcifications Detected during Organized, Low-Dose, Computed-Tomography Screening for Lung Cancer: Systematic Literature Review and Meta-Analysis

Sébastien Gendarme  1   2 , Helene Goussault  1 , Jean-Baptiste Assié  1   3 , Cherifa Taleb  4 , Christos Chouaïd  1   2 , Thierry Landre  5
Affiliations
Review

Impact on All-Cause and Cardiovascular Mortality Rates of Coronary Artery Calcifications Detected during Organized, Low-Dose, Computed-Tomography Screening for Lung Cancer: Systematic Literature Review and Meta-Analysis

Sébastien Gendarme et al. Cancers (Basel). .

Abstract

Although organized, low-dose, computed-tomography (CT) scan lung-cancer screening has been shown to lower all-cause and lung-cancer-specific mortality, the primary cause of death for subjects eligible for such screening remains cardiovascular (CV) mortality. This meta-analysis study was undertaken to evaluate the impact of screening-scan-detected coronary artery calcifications (CACs) on CV and all-cause mortality. We conducted a systematic review and meta-analysis of studies reporting CV mortality according to the Agatson CAC score for participants in a lung-cancer screening program of randomized clinical or cohort studies. PubMed, Embase, and Cochrane databases were screened in June 2020. Two authors independently selected articles and extracted data. Six studies, including 20,175 subjects, were retained. CV and all-cause mortality rates were higher for subjects with CAC scores >0, with respective relative risks of 2.02 [95% CI 1.23-3.32] and 2.29 [95% CI 1.00-5.21]. Both mortality rates were even higher for those with high CAC scores (>400 or >1000). CACs are more common in men than in women, with an odds ratio of 1.49 [95% CI 1.40-1.59]. The presence of CAC is associated with CV mortality with an RR of 2.05 [95% CI 1.20-3.57] in men and 2.37 [CI 95% 1.29-5.09] in women, respectively. Analysis of lung-cancer-screening scans for CACs is a tool able to predict CV mortality. Prospective studies within those programs are needed to assess the benefit of primary CV prevention based on CAC detection.

Keywords: cardiovascular mortality; coronary artery calcification; lung cancer screening; meta-analysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart for article selection.
Figure 2
Figure 2
Cardiovascular (A) and all-cause (B) mortality according to the presence of coronary artery calcifications. TE, estimate of treatment effect, e.g., log hazard ratio or risk difference; seTE, Standard error of treatment estimate; RR, relative risk.
Figure 3
Figure 3
Cardiovascular (A) and all-cause (B) mortality according to a high coronary artery calcifications score. TE, estimate of treatment effect, e.g., log hazard ratio or risk difference; seTE, Standard error of treatment estimate; RR, relative risk.
Figure 4
Figure 4
Cardiovascular events and mortality according to sex; TE, estimate of treatment effect, e.g., log hazard ratio or risk difference; seTE, Standard error of treatment estimate; RR, relative risk.
See this image and copyright information in PMC

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