title: Coronary artery calcium can predict all-cause mortality and cardiovascular events on low-dose CT screening for lung cancer.
abstract: OBJECTIVE
  Performing coronary artery calcium (CAC) screening as part of low-dose CT lung cancer screening has been proposed as an efficient strategy to detect people with high cardiovascular risk and improve outcomes of primary prevention. This study aims to investigate whether CAC measured on low-dose CT in a population of former and current heavy smokers is an independent predictor of all-cause mortality and cardiac events.
  
  
  METHODS
  We used a case-cohort study and included 958 subjects 50 years old or older within the screen group of a randomized controlled lung cancer screening trial. We used Cox proportional-hazard models to compute hazard ratios (HRs) adjusted for traditional cardiovascular risk factors to predict all-cause mortality and cardiovascular events.
  
  
  RESULTS
  During a median follow-up of 21.5 months, 56 deaths and 127 cardiovascular events occurred. Compared with a CAC score of 0, multivariate-adjusted HRs for all-cause mortality for CAC scores of 1-100, 101-1000, and more than 1000 were 3.00 (95% CI, 0.61-14.93), 6.13 (95% CI, 1.35-27.77), and 10.93 (95% CI, 2.36-50.60), respectively. Multivariate-adjusted HRs for coronary events were 1.38 (95% CI, 0.39-4.90), 3.04 (95% CI, 0.95-9.73), and 7.77 (95% CI, 2.44-24.75), respectively.
  
  
  CONCLUSIONS
  This study shows that CAC scoring as part of low-dose CT lung cancer screening can be used as an independent predictor of all-cause mortality and cardiovascular events.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, P.O. Box 85060, 3508 AB Utrecht, The Netherlands. p.c.a.jacobs@umcutrecht.nl
authors.forename: Peter C
authors.initials: PC
authors.lastname: Jacobs
authors.forename: Martijn J A
authors.initials: MJ
authors.lastname: Gondrie
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Ivana
authors.initials: I
authors.lastname: Isgum
authors.forename: Bram
authors.initials: B
authors.lastname: van Ginneken
authors.forename: Willem P T M
authors.initials: WP
authors.lastname: Mali
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000401:mortality; D002118:Calcium / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D003331:Coronary Vessels / Q000378:metabolism*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D002118:Calcium