177MO - Cardiovascular assessment in lung cancer screening: Initial findings from the European 4-IN-THE-LUNG-RUN trial

Background

The recently initiated 4-IN-THE-LUNG-RUN (4ITLR) trial, set to enroll 26,000 participants, presents an opportunity for prospective cardiovascular screening within a lung cancer screening program. While current guidelines recommend assessing coronary calcifications on any type of chest CT scan, achieving accurate Agatston scores requires specific imaging acquisition and reconstruction. This study aims to explore the potential benefits of cardiovascular screening in the initial participants of the 4ITLR trial.

Methods

Inclusion criteria comprised individuals aged 60-79 years with a smoking history of ≥35 pack-years, currently smoking or having quit within the last 10 years. High-temporal-resolution low-dose chest CT scans, utilizing a third-generation dual-source CT scanner, were conducted on 443 participants between January 15th and March 29th, 2023, at a single center. Automatic Agatston score assessment was performed on dedicated cardiac reconstructions with specific parameters, enabling reliable categorization of participants' cardiovascular risk.

Results

The mean age of participants was 68.6 years (SD 4.9), with 56.9% being male. Median Agatston scores were 242.1 (IQR 34.8-939.9) for men and 56.3 (IQR 2.5-365.0) for women. Participants were distributed into low, moderate, high, and very high coronary heart disease (CHD) risk categories at rates of 16.0%, 30.7%, 19.6%, and 33.6%, respectively. Approximately 47% fell into low/moderate CHD risk categories.

Conclusions

The initial lung cancer screening of the 4ITLR trial identified one-third of participants at significantly high CHD risk, with half deemed suitable for preventive CHD treatment. Notably, 16% had a low CHD risk, making them exempt from CHD preventive medication according to existing guidelines.

Legal entity responsible for the study

Erasmus Universitair Medisch Centrum Rotterdam.

Funding

The European Union's Horizon2020 Programme under grant agreement no 848294.

Disclosure

All authors have declared no conflicts of interest.