Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
Department of Cardiology, The Grace Ballas Cardiac Research Unit, Sheba Medical Center, Tel Hashomer, Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel.
Eur Radiol. 2020 Dec;30(12):6847-6857. doi: 10.1007/s00330-020-07049-4. Epub 2020 Jul 28.
Smoking is a major risk factor for both cardiovascular disease (CVD) and lung cancer. Aortic valve calcification (AVC) and coronary artery calcification (CAC) are both due to atherosclerotic disease. We aim to investigate whether AVC on low-dose CT (LDCT) predicts death from CVD in smokers beyond that provided by CAC.
We reviewed a prospective cohort of 8618 smokers enrolled in LDCT screening for lung cancer in New York State between June 2000 and December 2005. As of December 2009, 169 of the 643 deaths were due to CVD; median follow-up time was 96.4 months. Visual AVC was assessed as being absent (AVC = 0) or present (AVC > 0). CAC ordinal scores of 0-12 were categorized into three validated prognostic categories (0, 1-3, and 4-12). Cox proportional hazards regression analysis was used to assess whether AVC > 0 increased the risk of CVD death, after adjustment for CAC categories and other risk factors.
The prevalence of AVC significantly increased (p < 0.0001) with the increasing severity of the CAC categories; Pearson, Spearman, and Kendall's correlation coefficients showed a significant correlation between AVC and CAC with r = 0.29, ρ = 0.32, and τB = 0.28 (all p values < 0.0001), respectively. CAC and AVC were significant predictors of CVD death when considered alone using multivariable Cox regression analysis (adjusted HR of CAC = 1.57, p = 0.04; adjusted HR of AVC = 1.39, p = 0.045). When AVC > 0 and CAC ≥ 4, the hazard ratio was 2.35 (95%CI 1.57-3.50) compared with the reference group of AVC = 0 and CAC < 4, when adjusted for other risk factors.
The presence of AVC identified on LDCT is a significant predictor of future CVD death, particularly for those with ordinal CAC score ≥ 4.
• Aortic valve calcification (AVC) and coronary artery calcification (CAC) are both due to atherosclerotic disease. The prevalence of AVC in lung cancer screening cohort significantly increased with the increasing severity of CAC. • CAC and AVC were significant predictors of cardiovascular disease (CVD) death when considered alone. Participants who underwent lung cancer screening with AVC > 0 and CAC ≥ 4 had more than a 2-fold increased risk of CVD death than the group with AVC = 0 and CAC < 4, when adjusted for other risk factors.
吸烟是心血管疾病（CVD）和肺癌的主要危险因素。主动脉瓣钙化（AVC）和冠状动脉钙化（CAC）均归因于动脉粥样硬化疾病。我们旨在研究在吸烟者中，低剂量 CT（LDCT）上的 AVC 是否可以预测 CAC 以外的 CVD 死亡。
我们回顾了 2000 年 6 月至 2005 年 12 月期间在纽约州进行 LDCT 筛查肺癌的前瞻性队列研究中的 8618 名吸烟者。截至 2009 年 12 月，643 例死亡中有 169 例归因于 CVD；中位随访时间为 96.4 个月。视觉 AVC 评估为无（AVC=0）或存在（AVC>0）。CAC 序数评分 0-12 分为三个经验证的预后类别（0、1-3 和 4-12）。使用 Cox 比例风险回归分析，在校正 CAC 类别和其他危险因素后，评估 AVC>0 是否增加 CVD 死亡的风险。
随着 CAC 类别的严重程度增加，AVC 的患病率显著增加（p<0.0001）；Pearson、Spearman 和 Kendall 相关系数分别显示 AVC 与 CAC 之间存在显著相关性，r=0.29、ρ=0.32 和τB=0.28（所有 p 值均<0.0001）。多变量 Cox 回归分析单独考虑 CAC 和 AVC 时，均为 CVD 死亡的显著预测因素（CAC 的调整 HR=1.57，p=0.04；AVC 的调整 HR=1.39，p=0.045）。当 AVC>0 且 CAC≥4 时，与 AVC=0 且 CAC<4 的参考组相比，危险比为 2.35（95%CI 1.57-3.50），在调整其他危险因素后。
LDCT 上存在 AVC 可显著预测未来 CVD 死亡，尤其是对于 CAC 序数评分≥4 的患者。
AVC 和 CAC 均归因于动脉粥样硬化疾病。肺癌筛查队列中 AVC 的患病率随着 CAC 严重程度的增加而显著增加。
CAC 和 AVC 是 CVD 死亡的重要预测因素。与 AVC=0 且 CAC<4 的组相比，在肺癌筛查中接受 AVC>0 且 CAC≥4 的参与者发生 CVD 死亡的风险增加了两倍以上，在校正其他危险因素后。
