肺癌筛查人群中的心血管风险：一项多中心研究评估冠状动脉钙化与预防性他汀类药物处方之间的关系。
Cardiovascular Risk in the Lung Cancer Screening Population: A Multicenter Study Evaluating the Association Between Coronary Artery Calcification and Preventive Statin Prescription.
机构信息
Fellowship Director of Cardiothoracic Radiology, Research Director, Duke Lung Cancer Screening Program, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest, North Carolina.
出版信息
J Am Coll Radiol. 2021 Sep;18(9):1258-1266. doi: 10.1016/j.jacr.2021.01.015. Epub 2021 Feb 26.
OBJECTIVE
Coronary artery calcification (CAC) is a marker of atherosclerotic cardiovascular disease (ASCVD), the leading cause of death in individuals receiving lung cancer screening (LCS) with low-dose CT. Our purpose was to determine the proportion of the LCS population eligible for primary ASCVD preventive statin therapy by American College of Cardiology/American Heart Association guidelines, assess statin prescription rates among statin-eligible individuals, and determine associations of CAC on downstream statin prescribing within 90 days of LCS.
METHODS
Individuals receiving LCS between January 1, 2016, and December 31, 2018, across three centers were retrospectively enrolled. Statin eligibility in individuals without pre-existing ASCVD was determined by 2013 American College of Cardiology/American Heart Association guidelines: (1) low-density lipoprotein ≥190 mg/dL, (2) diabetes, or (3) ASCVD risk score ≥7.5%. CAC presence and severity (mild, moderate, heavy) were extracted from LCS reports. Variation in statin prescription rates and associations between CAC and statin prescription were determined using mixed-effects logistic regression.
RESULTS
Of 5,495 individuals receiving LCS, 31.4% (1,724 of 5,495) had pre-existing ASCVD. Of the remaining 3,771 individuals, 73.6% were statin eligible (2,777 of 3,771). However, most lacked statin prescription (60.5%, 1,681 of 2,777). CAC was associated with downstream statin prescribing (adjusted odds ratio = 2.60, 95% confidence interval: 1.12-6.02), with a higher likelihood of statin prescribing with increasing CAC severity (adjusted odds ratio = 2.21, 95% confidence interval: 1.35-3.60).
CONCLUSION
Although most of the LCS population is eligible for guideline-directed statin therapy, statins are underprescribed in this group. Radiologist reporting of CAC at LCS reflects a potential opportunity to raise awareness of ASCVD risk and improve preventive statin prescribing.
目的
冠状动脉钙化（CAC）是动脉粥样硬化性心血管疾病（ASCVD）的标志物，是接受低剂量 CT 肺癌筛查（LCS）的个体死亡的主要原因。我们的目的是确定符合美国心脏病学会/美国心脏协会指南的 LCS 人群中接受一级 ASCVD 预防性他汀类药物治疗的比例，评估符合他汀类药物治疗条件的个体中的他汀类药物处方率，并确定 CAC 与 LCS 后 90 天内他汀类药物处方之间的关联。
方法
回顾性纳入 2016 年 1 月 1 日至 2018 年 12 月 31 日期间在三个中心接受 LCS 的个体。无 ASCVD 既往史的个体的他汀类药物适应证通过 2013 年美国心脏病学会/美国心脏协会指南确定：（1）低密度脂蛋白≥190mg/dL，（2）糖尿病，或（3）ASCVD 风险评分≥7.5%。从 LCS 报告中提取 CAC 的存在和严重程度（轻度、中度、重度）。使用混合效应逻辑回归确定他汀类药物处方率的变化和 CAC 与他汀类药物处方之间的关联。
结果
在接受 LCS 的 5495 名个体中，31.4%（1724/5495）有 ASCVD 既往史。在其余的 3771 名个体中，73.6%（2777/3771）符合他汀类药物适应证。然而，大多数人缺乏他汀类药物处方（60.5%，1681/2777）。CAC 与下游他汀类药物处方有关（调整后的优势比=2.60，95%置信区间：1.12-6.02），随着 CAC 严重程度的增加，他汀类药物处方的可能性更高（调整后的优势比=2.21，95%置信区间：1.35-3.60）。
结论
尽管大多数 LCS 人群符合指南指导的他汀类药物治疗，但该人群中他汀类药物的处方不足。在 LCS 中报告 CAC 可能为提高 ASCVD 风险意识和改善预防性他汀类药物处方提供机会。
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